State Program Management Unit-NHM
RECORD OF PROCEEDING (RoP)
UTTARAKHAND
District: Tehri
2020-21
NATIONAL HEALTH MISSION
District Tehri RoP 2020-21
Chapter Name of Programme Approval in Number lakhs
1 Maternal Health 115.34 2 Child health 28.91 3 Family planning 46.26 4 RKSK 103.54 5 RBSk plus Haemoglobinopathy 61.33 6 PCPNDT 1.55 7 Human Resource ( Programme Management HR , mobility and service delivery HR) 790.77
8 Immunization 77.95 9 ASHA 210.14 10 Untied fund 148.88 11 Health and Wellness Centres 111.2 12 Infrastructure and civil works 11.28 13 IEC 24.77 14 Quality Asssurance and Kayakalp 4.00 15 HMIS 10.42 16 Free drug Programme 00 17 Free diagnostic Programme 00 18 Blood services 00
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19 IDSP 18.36 20 NVBDCP 4.67 National Viral hepatitis control programme 0.55 National Programme for Climate Change and 21 Human Health 1.49 National Rabies Control Program 22 1.30 23 NLEP 6.48 24 RNTCP 80.85 25 NCD National Programme for Prevention and Control of 23.50 Cancer, Diabetes, Cardiovascular Diseases and Stroke NPCDCS
National Tobacco Control Programme 9.13
National Programme for Control of Blindness and 38.26 Visual Imapirement (NPCB& VI) National Mental Health programme (NMHP) 2.72
National Programme for the Healthcare of the 4.20 Elderly (NPHCE) National Oral health programme (NOHP) 8.10
National Programme for Prevention and Control 0.20 of Deafness (NPPCD) National Programme for Palliative Care (NPPC) 0.60
Pradhan Mantri National Dialysis Program 0 (PMNDP) National Iodine Deficiency Disorders Control 0.61 Program 1947.34 Total 122.86 Committed 2070.20 Grand Total
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RoP Conditionalities
1. The support under NHM is intended to supplement and support, and not to substitute state expenditure. All the support for HR will be to the extent of positions engaged over and above the regular position as per IPHS and case load. NHM aims to strengthen health systems by supplementing, and hence it should not be used to substitute regular HR. All states are encouraged to create sanctioned regular positions as per their IPHS requirement. HR should only be engaged when infrastructure, procurement of equipment etc. required to operationalize the facility in place.
2. Action on the following issues would be looked at while considering the release of funds: District has to ensure the timely Submission of Monthly FMR (Financial Management Report) & SoFP (Statement of Fund Position) as per New FMR format on Monthly basis by 7th of following month mandatorily. After completion of the financial year 2020- 21, Districts must submit their provisional Balance Sheet including all Annexures with Utilization certificate to State Health Society by 15th April 2021. Submission of the Statutory Audited Balance Sheet for the FY 2019-20 with All Annexures including Utilization Certificate (As per 12-C Format). District must ensure to open accounts of all agencies in PFMS and also ensure expenditure capturing, State have already given the training to all districts officers/concerned Accounts staff District has to ensure to clear all “Advance Under Review” pendency. Ensure timely action for engagement of CA Firms as Monthly Concurrent Auditors for NHM Audit at their district for the FY 2019-20 & also submit the Monthly Concurrent Audit Report to State Health Society on Monthly basis by 15th of the following Month . All approvals are subject to the framework for Implementation of NHM and guidelines issued from time to time and the observations made in this document. The Record of Proceedings (RoP) document conveys the summary of approvals accorded by NPCC based on the State/Districts PIP/RoP. District should maintain their programme accounts of NHM as per Operational Guidelines for Financial Management Manual.
Finance District should convey the Block wise approvals within 15 days of receiving the District RoP approvals and also submit a copy to State Health Society. All funds under NHM will be released from State Health Society to DHFWS in a pool , not activity wise or FMR Code wise. Districts are entitled to use these funds on need basis by allocating internally the funds from one pool to another pool in case of shortage of fund in a particular pool but activity must be approved from GoI and the proposed expenditure should not cross the approved limit under any FMR Code as given in District RoP. DHFWS should also communicate State Health Society about details of fund allocated from one pool to another pool at the end of each month along with FMR / SoFP. The District must ensure due diligence in expenditure and observe, in letter and spirit, all rules, regulation, and procedure to maintain financial discipline and integrity particularly with regard to procurement; competitive bidding must be ensured, and only need- based procurement should take place.
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All procurement to be based on competitive and transparent bidding process. The unit cost/rate approved for all activities including procurement, printing, etc are indicative for purpose of estimation. However, actual are subject to transparent and open bidding process as per the relevant and extant purchase rules/ Uttarakhand Procurement Rules 2017 (revised). Third party monitoring of works and certification of their completion through reputed institutions will be introduced by SHS to ensure quality. In addition, information on all ongoing works to be shared with State for displaying it further on the State NHM website District has to ensure regular meetings of District Health Mission/ Society. The performance of DHS along with financials audit report must be tabled in meetings of DHFWS as well as District Health Mission’s meetings. The accounts of District Health Society shall be open to inspection by the sanctioning authority and audit by the Comptroller & Auditor General of India under the provisions of CAG (DCP) Act 1971 and internal audit by Principal Accounts Officer of the Ministry of Health & Family Welfare/ GoI. District shall ensure submission of details of unspent balance indication inter alia, funds released in advances & funds available under District Health Societies. The district shall also intimate the interest amount earned on unspent balance. This amount can be spent against approved activities. Every district has to ensure timely renewal of registration of their DHFWS. In case of non- compliance, State would not be in the position to release funds to the concerned DHFWS.
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Chapter 1 Maternal Health
Maternal and Child Health program Health been designed and developed as an innovative and integrated approach for improving RMNCH+A Health Outcomes. The initiative has been built upon both Community & Facility Level Interventions with focus on improving both demand and delivery of services & for ensuring Respectful & Quality Care across all levels. Successful implementation of the initiative would lead to decrease in Maternal & Newborn Mortality in the State.
AIM: Achieving Positive Pregnancy Experience & Outcomes.
Primary Objectives:
1) Delivery of Respectful & Quality Care for, a) Better Antenatal (ANC) Services during pregnancy b) Better Care around Birth (Delivery) Services c) Better Postnatal (PNC) Services during post delivery period
2) Strengthen Maternal & Neonatal Death Surveillance & Response System
STATE GOALS:
Immediate Goals: To be achieved by 2020-21 - Number of 4 ANC Visits are to be increased 2.5 times of current coverage ie from current 31% (NFHS-4:2015-16) to more than 75% of all ANC. - Number of Full ANC coverage is to be increased 3 times of current coverage ie from current 12% (NFHS-4:2015-16) to more than 50% of all ANC. - Number of 1st trimester ANC Visits are to be increased from current 61% (HMIS 2017-18) to more than 90% of all ANC. - Number of High Risk Pregnancy Detection is to be increased 4 times of current coverage ie from current rates of 1% (MCTS:2016-17) to > 4% - Achieve Birth Planning rates of greater than 80% - Increase Institutional Delivery rates from 69% (NFHS-4:2015-16) to > 85% - Increase Safe Delivery Rates from current 73% (NFHS-4:2015-16) to > 90% - Bring Home Delivery Rates to single digits (less than 10%) across all Blocks - Improve Access to Delivery Points (DP’s) and 2 times availability of DP’s at PHC level from current 35% to > 70%
Long Term Goals: To be achieved before 2025-26 - Achieve Sustainable Developmental Goals for Maternal & Newborn Health by year 2025- 26; five years before the expected timelines in 2030. . Maternal Mortality Ratio (MMR) – Below 70 per 1 lakh live births . Neonatal Mortality Rate (NMR) – Below 12 per one thousand live births
PRIORITY INTERVENTIONS:
1) Organize Fixed ANC & PNC Service Day (Samman Divas) at Sub-Center Level every Monday
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2) Focus on ANC Counselling&Birth Planning and use of ANC Counselling & Training Wall & Birth Plan cards. 3) Conduct Facility Level Emergency Drills in the Labor Room every week. 4) Track and ensure availability of Key commodities as listed in GOI RMNCH+A 5x5 Matrix. 5) Ensure regular Online Data Reporting on Samman portal, SNCU Online and PMSMA Portal. Use of Scorecards for recognizing Health Providers & Teams and address gaps. 6) Organizing Quarterly Review & Facilitation Event at District level
EXPECTATIONS: 1) Improve Demand for Institutional Deliveries, 2) Improve Access to Delivery Points based on Time to Care approach, 3) Better provisions, availability & development of Human Resource for Health a. Fill Vacant Sub Centers to achieve average Vacant Subcenter Rates below 2% to total Subcentres at any given point. b. Rationale case based deployment of HR at all levels. Calculate requirements for the Post of Specialists, Medical Officers, and Staff Nurses & ANM’s to below 2%. 4) Improve Screening, Monitoring, Treatment, Referral & Follow-Up Processes for Maternal & Newborn Health related services 5) Standardize Recording & Reporting Processes 6) Strengthen Review & response Systems and, 7) Build Recognition Platforms
MCH MORTALITY INDICATORS IN UTTARAKHAND Table 1 Name of Maternal Neo Early Neo Infant U5 % District Mortality Natal Natal Mortality Mortality Contribution Ratio Mortality Mortality Rate Rate of NMR to (MMR) Rate Rate (ENMR) (IMR) (U5MR) U5MR (NMR) Data Source: AHS - 2012-13 Almora 182 15 20 24 63 Bageshwar 182 20 31 38 53 Chamoli 158 17 26 29 59 Champawat 182 24 34 42 57 Dehradun 158 25 Not Available 34 40 63 Garhwal 158 25 37 45 56
Haridwar 158 45 64 77 58
Nainital 182 20 29 36 56
Pithoragarh 182 14 23 27 52
Rudraprayag 158 11 19 26 42 Tehri Garhwal 158 38 53 65 58 US Nagar 182 27 35 44 61 Uttarkashi 158 26 42 51 51 Uttarakhand 1 201 30 24 38 41 73 Goal < 70 < 12 Goals to be achieved before 2025-26
1 For State Recent SRS Data has been displayed. (MMR Bulletin 2015-16 & Detailed SRS Reports 2016)
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Goals are to be achieved before 2025-26 period i.e.MMR below 70; NMR below 12. These goals are par with the Sustainable Development MCH Goals (SDG) 2030. Since NMR contribution to under five mortality in Uttarakhand is very high at 73%, if the NMR goals are achieved the U5MR goal of 25 under SDG would be simultaneously achieved.
Performance Benchmarks for DPMU- To achieve NHM target, District CMO to ensure to achieve below mentioned indicators. This is the key responsibilities of DPM/DDM and DAM (for Sr. No. 11).
Maternal Health Benchmarks Sr. No. Indicators 1 ANC (% of Pregnant women registered within the first trimester) 90% 2 ANC (% of Pregnant women who had at least one ANC visit ) 100% 3 Institutional Deliveries 90% Home deliveries attended by SBA (Skilled Birth Attandance) 85% trained health worker out of total no. of reported home 4 deliveries. Ensure that all pregnant women delivering in Government 100% Health institutions receives JSSK benefits of Drugs, 5 Diagnostics, diet, pick-up and drop back (as per DBT portal) District Hospitals and SDH to be certified for LaQahya State 100% level certification 6 Conduct all the trainings approved in the Maternal Health 100% 7 Program 8 Reporting of all estimated maternal deaths 80% All reported deaths are reviewed, and action plans are 100% 9 developed Ensure that all beneficiaries are reported on RCH portal and 100% JSY payments are done after that. 10 Ensure e-payments to all JSY beneficiaries 100% 11 12 Make minimum 2 field visits in a month to facilities 100% Conduct at least one review meeting with block in every month 100% to bring out continuous improvement in Maternal health service 13 delivery/quality. Submit filled Monthly/Quarterly reports (by e-mail as well as 100% physical copy) to the office of State NHM latest by 10th day of 14 the next month.
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Key Strategies for quality care-
• High Risk Clinic managed by OBGYN Specialist •Involvement of specialist from Private Sector •Rotary, Lions, NGO’s to be involved PMSMA* •Voucher Scheme (9th of every •Additional PMSMA Session on 25th month) • & All the care listed below
Routine ANC • Blood Group Test Clinic (At L2 •Management of High Blood Pressure / Pre Eclampsia PHC & •Access to Comprehensive Abortion Care Higher Level) •PPTCT & USG Services at L3 Level •& All the care listed below
•Abdominal Examination – FHS, Fundal Height & Sub Center Position / Lie (Samman Divas - •Urine Testing – Albumin & Sugar, Blood Sugar – Fixed ANC / PNC Screening for Diabetes, HIV & Syphilis Screening, Day – Every Malaria Testing Monday at SC •Screening & Management of RTI/STI & All the Level) care listed below
•Pregnancy Test, Registration, Full Medical History VHND – (At , ANC Counselling & Birth Planning, BP, Temperature, Weight, Hb% Testing Community Level) •Vaccination, TT, IFA, Calcium, Albendazole •HRP Identification, Tracking & Follow-Up and Infection Prevention (IMEP Protocol)
Respectful Care – 7 Client Rights –1) Freedom from Harm; 2) Informed Choice; 3) Privacy & Confidentiality; 4) Dignity & Respect; 5) Equality; 6) Highest Level of Healthcare; 7) Freedom from Coercion
Five Key ANC Goals 1.1 – Ensure completeness of 4 ANC visits; 1.2 - One additional visit to Higher Center where Blood Grouping test is available; 1.3 - Build Beneficiary awareness on a) Nutrition, b) Danger Signs in Pregnancy & Post Pregnancy Period, c) Government Programs - JSY, JSSK, Maternity Benefit Scheme, 108, 104 Schemes 2.1 – Ensure 180 IFA & 360 Calcium + Vit. D3 consumption during ANC & PNC Period ; 2.2 - Complete TT Vaccination 3 – Support the women in choosing her Post-Pregnancy family Planning Method (PPFP). 4 – Help the pregnant women in selected her delivery point based on her PPFP needs 5 – Prepare the pregnant women for exclusive breast feeding.
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Components of Birth Plan
1) Choice of Post-Partum Family Planning Method; 2) Name of Identified Delivery Point; 3) Name of Birth Companion; 4) Transport Choice; 5) Emergency Preparedness
In the view of above, it is important for District to strengthen their data reporting mechanism to ensure accurate reporting of data across all levels of facilities. The analysis of this data would not only serve as an important parameter for improving the effectiveness of program implementation, but can also leverage for policy correction.
U1 Service Delivery Facility Based
Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA)-
Carrying forward the vision of our Hon’ble Prime Minister, the Pradhan Mantri Surakshit Matritva Abhiyan was launched in 2016 to ensure quality antenatal care to pregnant women in the country on the 9th of every month.
Janani Shishu Suraksha Karyakaram (JSSK)-
District must provide for all JSSK entitlement schemes mandatorily. No beneficiary shall be denied any entitlement because of cost estimates/any other reason. If there are variations in cost., it must be examined and ratified by the RKS.
JSSK approval is subject to ensuring that there is no duplication under free drugs and diagnostic initiative under NHM.
New Old Budget Head Unit Quantity/ Amount Remarks FMR FMR Cost Target Approved Code Code (Rs.) (Rs. in Lakhs) 1.1.1.1 A.1.5.4 PMSMA activities at 50000 1# 0.50 Approved as per State & District Level following details 1# PMSMA (FMR Code- 1.1.1.1) Activity approved for activities such as sensitization of stakeholders, meetings of committees, IEC campaigns, miking, hording, banner, sensitization of govt. functionaries and refreshment for beneficiaries and service providers etc. Ensure to follow the PMSMA Guideline. Diet services for 300 1560 4.68 As per JSSK JSSK Beneficiaries (3 guideline diet for days for Normal Normal 1.1.1.2 A.1.6.3 Delivery and 7 days Deliveries. for Caesarean) 500 38 0.19 As per JSSK guideline diet for C-Section cases Activity- Blood Transfusion for JSSK Beneficiaries (FMR Code 1.1.1.3)- Blood transfusion may be required to tackle emergencies & complications of deliveries such as management of severe anaemia, PPH and C-section etc. The provision of blood will be free of any cost and without any user charges; however, the relatives and attendants accompanying the pregnant women should be encouraged to donate blood for replacement. No beneficiaries will be denied, if replacement of blood donation is not available.
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1.1.1.3 A.1.6.2 Blood Transfusion for 0 0 0 No budget JSSK Beneficiaries proposed by district.
1.1.1.5 LaQshya Related 0 0 0 Activities
1.1.1.6 A.1.5.7 Special incentive for 2000 25 0.50 Approved. people helping pregnant women transportation in doli in difficult accessible villages 1.1.1.6 A.1.5.8 Incentive for Safe 150 60 0.09 Approved Rs. abortions to ASHA 150/- per case for and beneficiary ASHA for bringing beneficiaries for safe abortion services 1.1.1.6 A.1.5.1 For detection and 0 0 0.0 No budget 0 follow up of high risk proposed by pregnancy (incentive district. for HPDs only) 1.1.1.6 A.1.5.1 Incentive for SBA 0 0 0.0 No budget 1 trained ANM for proposed by conducting Home district. Delivery in notified villages which are hard to reach area as per PBI guideline Incentive for 0 0 0.0 No budget MO/ANM/SN/Supporti proposed by A.1.5.1 ng Staff of CHC (non- district. 1.1.1.6 3 FRU) conducting Institutional Delivery as per PBI Guideline 1.1.1.6 A.1.5.1 Incentive for team 0 0 0.0 No budget 4 members as per PBI proposed by guideline for district. conducting C-section at SDH/CHC –FRU 1.1.1.6 A.1.5.1 Incentive for team 0 0 0.0 No budget 5 members as per PBI proposed by Guideline for district. conducting C-section at DH
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1.1.1.6 A.1.5.1 Incentives to ANMs 0 0 0 No budget 6 at delivery points proposed by (sub centers and district. PHC) for promoting institutional deliveries as per PBI Guideline 1.2.1.1 A.1.3.1 Home Deliveries 500 80 0.40 Approved @ Rs. under JSY 500/- per Case of BPL Home delivery case. 1.2.1.2 A.1.3.2 Institutional Deliveries 1400 3793 53.10 Approved @ Rs. .1 .a (Rural) under JSY 1400/- per rural case. Most Important-
District to ensure that JSY payments are made through Direct Benefit Transfer (DBT) mechanism through AADHAAR enabled payment system, through NEFT under Core Banking Solution. 1.2.1.2 A.1.3.2 Institutional Deliveries 1000 80 0.80 Approved @ Rs. .2 .b (Urban) under JSY 1000/- per urban case. Most Important-
District to ensure that JSY payments are made through Direct Benefit Transfer (DBT) mechanism through AADHAAR enabled payment system, through NEFT under Core Banking Solution.
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1.2.1.2 A.1.3.2 Hiring Pvt. Doctor for 0 0 0.0 .3 .c C-Section under JSY
U.1 Service Delivery - 60.26 Facility Based
U2 Service Delivery - Community Based
The Village Health and Nutrition Day (VHNDs)-
VHNDs serves as a platform for the ANM to provide all outreach services such as ANC, PNC, family planning, immunisation, treatment for sick children and making of blood slides in fever cases. Both the AWW and ASHA support the ANM by mobilising those children, pregnant women and sick persons in need of care, to attend the VHND. In VHND, the provision of immunisation and antenatal care is also undertaken. The ASHA should also help to make it a community event, and make a special effort to ensure that women living in hamlets and those from marginalised communities are reached with services. To increase the coverage and effectiveness of VHNDs, it is suggested that detailed mapping of remote hamlets and small villages be carried out so as to ensure that every hamlet has access to VHND within 20 minutes of travel time. The selected sites should have provision of basic amenities including privacy for examining pregnant women. The monitoring of VHND by PRI/VHSNC would ensure occurrence, quality and comprehensiveness of services.
Line listing and follow-up of severely anaemic women-
Anaemia emerging as one of the major contributing factors for maternal deaths, line listing of severely anaemic women, tracking pregnant women with severe anaemia for treatment and tracking these women during pregnancy and childbirth must receive high priority. The ANMs and PHC In-charges have been identified as the nodal officers for this purpose and must ensure timely and appropriate management of severely anaemic women.
New Old Budget Unit Quantity/ Amount Remarks FMR FMR Head Cost Target Approved Code Code (In (Rs. in Rs.) Lakhs) 2.3.1.1.2 A.1.2.2 Monthly 125 7779 9.72 Approved for Village organizing VHND @ Health and Rs. 125/- per VHND Nutrition subject to ensuring Days that Comprehensive ANC, INC and PNC services provided to pregnant women as per VHND Guidelines. 2.3.1.2 A.1.5.1 Line listing 100 140 0.14 Approved for ANM and follow-up (Sub- Centre) as of severely incentive for line-
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anaemic listing and follow up of women severely anaemic pregnant women. U.2 Service Delivery - 9.86 Community Based
U3 Community Interventions
Janani Suraksha Yojhana-
It should be ensured that ASHA keeps track of all expectant mothers and newborn. All expectant mother and newborn should avail ANC and immunization services, if not in health centres, at least on the monthly health and nutrition day, to be organised in the Anganwadi or sub-centre:
o Each pregnant women must be registered and a micro-birth plan to be prepared. o Each pregnant woman must be tracked for ANC. o For each of the expectant mother, a place of delivery should be pre-determined at the time of registration and the expectant mother to be informed and to provide MCP card mandatorily. o A referral centre is identified and expectant mother to be informed. o Counsel for institutional delivery o Escort the beneficiary women to the pre-determined health center and stay with her till the woman is discharged.
New Old Budget Head Unit Quantity/T Amount Remarks FMR FMR Cost arget Approved Cod Code (Rs.) (Rs. in e Lakhs) ASHA Incentive 2974 17.84 Approved @ Rs. 600/- for Rural cases 600 per rural case for 3.1.1 A.1.3. under JSY ASHA incentive .1 4 ASHA Incentive 0.48 Approved @ Rs. 400/- for Urban cases 400 120 per urban case for under JSY ASHA incentive U.3 Community Interventions 18.32
U4 Untied Fund
New Old Budget Unit Cost Quantity/Ta Amount Remarks FMR FMR Head (Rs.) rget Approved Code Code (Rs. in Lakhs) NIL 0 0 0 0 0
U5 Infrastructure- NIL
U6 Procurement
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All procurement to be based on competitive and transparent bidding process.
The unit cost/rate approved for all activities including procurement, printing, etc are indicative for purpose of estimation. However, actuals are subject to transparent and open bidding process as per the relevant and extant purchase rules.
New Old FMR Budget Head Unit Quantity/ Amount Remarks FMR Code Cost Target Approved Code (Rs.) (Rs. in Lakhs) 6.1.1.1 NA MVA/EVA for safe 3000 2 0.06 Approved for .1 abortion services MVA Syringe/kit 6.1.1.1 NA Procurement under 150000 1 1.50 Budget of Rs. .2 LaQshya 1.50 lakhs approved for 1 Labour- Delivery- Recovery- Beds (LDR) @ Rs. 1.50 Lakhs per Labour (LDR) bed
6.1.1.1 NA Equipment for 0 0 0 .3 Obstetric ICUs/ HDUs (as per operational guidelines of ICUs and HDUs, 2017) Drugs for Safe 20000 1 0.20 6.2.1.2 B.16.2.1.2 Abortion (MMA) JSSK Drugs for 350 3202 11.21 Approved Pregnant Women 6.2.1.7 B.16.2.1. (Normal & C- .5 3.1 Section Delivery cases) 6.2.1.8 B.16.1.2. Any other drugs 0 0 0.0 3 and supplies (Please specify) 6.4.3 A.1.6.1 Free Diagnostics 2500 5.0 Approved. for Pregnant 200 women under JSSK U.6 Procurement 17.97
U8 Service Delivery- Human Resource
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New Old Budget Unit Cost Quantity/Ta Amount Remarks FMR FMR Head (Rs.) rget Approved Code Code (Rs. in Lakhs)
HR ROP shared separately.
U9 Training & Capacity Building
New Old Budget Head Unit Quantity/ Amount Remarks FMR FMR Cost Target Approved Code Code (Rs.) (Rs. in Lakhs) Budget approved for training on Combined MDR, CDR training @Rs. 15 SN & 5 Maternal Death 0.52 52,000/- per district 9.5.1.1 A.1.4 MO Review Trainings for Gynaecologist/Paedi atrician, MOs and SNs.
10143 Budget approved for 0 training of 1 batches of 4 ANM/LHV/SNs Training of Staff (Selecteed from A.9.3.1. 9.5.1.6 Nurses/ANMs / 1 1.01 High home delivery 3 LHVs in SBA areas) per batch for a period of 21 days @ Rs. 101430/- per batch.
Budget approved for Dakshata training at district level for 1 batch comprising of 14 (7 MOs and 7 9.5.1.1 DAKSHTA 7 MO & 7 1.42 SNs/ANMs) of 9 training SN LaQshya facilities/DH/SDH/Hi gh case load facility for 3 days @ Rs. 1.42 Lacs per batch.
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LaQshya Budget approved for 9.5.1.2 trainings/worksho one day district 16000 1 0.16 2 ps (Orientation Orientation under under Laqshya.) Laqshya.
LaQshya 1700 8 0.136 Budget approved for trainings/worksho mentoring visits by 9.5.1.2 ps (Mentoring District Coaching
2 visits by District Teams of LaQshya Coaching facilities as per Teams) LaQshya guideline.
LaQshya Budget approved for trainings/worksho District Review 9.5.1.2 ps (District Meetings of 10000 4 0.40 2 Review Meetings LaQshya facilities as of LaQshya per LaQshya facilities) guideline.
Facility Quality Improvement team Meetings, One Facility Level QI meeting will be conducted every LaQshya month. QI Learning trainings/worksho Cycle will also be 9.5.1.2 ps (Facility 500 12 0.06 part of the QI 2 Quality Meeting and would Improvement be the responsibility team Meetings) of Quality Circle members trained in Rapid Improvement QI Cycle during District Level Orientation.
Other maternal 9.5.1.2 Approved as detail health trainings 69500 1 0.695 7 given below (please specify)
Other maternal health trainings (please specify) (FMR Code- 9.5.1.27)- Budget approved for one batch of 35 participants for 1 day training of Gynaecologist, Staff Nurses on Safe delivery App for Medical College/DH/SDH/CHC/High load delivery points@ Rs. 69500 /-. U.9 Training & Capacity 4.41 Building
U10 Review, Research, Surveillance and Surveys
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Maternal Death Surveillance & Response (MDSR) or MDR is a continuous cycle of identification, notification and review of maternal deaths followed by actions to improve quality of care and prevent future deaths.
The Chief Medical Officer (CMO) is mainly responsible for the Maternal Death Reviews at the District level. Both facility and community based reviews from rural and urban areas would be taken up at this level.
New Old Budget Head Unit Quantity/Ta Amount Remarks FMR FMR Cost rget Approved Code Code (Rs.) (Rs. in Lakhs) 10.1.1 A.1.4 Maternal Death 1075 12 Follow the MDSR Review (both in Guideline. (Budget institutions and 0.13 released for community) Incentive purpose only).
U.10 Review, Research, 0.13 Surveillance & Surveys
U11 IEC/BCC- Refer IEC Section
U12 Printing
New FMR Old FMR Budget Unit Quantity/T Amount Remarks Code Code Head Cost arget Approved (Rs.) (Rs. in Lakhs) 12.1.1 A.1.4 Printing of 600 9 0.054 Budget MDR approved for formats each block for printing the MDR Formates and provided to ASHA , ANM and facilities for FBMDR and CBMDR, MDR line listing and register for MDR also as per MDSR Guideline.
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71428 2 1.43 Budget approved for vaious register, BHT, Protocol Printing of posters etc for labor room LaQshya registers facilities to be and printed and 12.1.3 casesheet provided to s/ LaQshya LaQshya Hospitals to related promote printing quality in the maternity care and achieve LaQshya National Certification.
U.12 Printing 1.48
U13 Quality Assurance -NIL
U14 Drug Warehousing & Logistics -NIL
U15 PPP -NIL
U16 Programme Management
Fund released under JSY Administrative Expenses could be utilized towards administrative expenses like monitoring, IEC and office expenses for implementation of JSY by the district respectively. This fund could be utilized for giving Rs. 25 per case as incentive to ASHA to open the bank account of beneficiary & also link the account with Aadhar number.
Possible IEC strategy:
To associate NGO and Self Help Groups for popularizing the scheme among women’s group and also for monitoring of the implementation.
To provide wide publicity to the scheme by:
I. Promoting JSY as a component of total package of services under RCH along with Monthly Village Health Day, Health Melas etc. II. Printing and distributing JSY guidelines, pamphlets, notices in local languages at SC/PHCs/CHCs/ District Hospitals/ DM’s and Divisional Commissioner’s office in abundance.
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III. Printing of birth plan card and Case Sheet for Maternity Services - L1 facility, L2 facility and L3 facility. IV. Supporting printing of district’s stationery, specially for DMs /SDMs/ Block/ PHC/ CHC/ District Hospital, advocating on Institutional Delivery and cash benefits of JSY and JSSK. V. Wall painting in all sub-centers, PHCs and CHCs, District Hospitals. VI. Ensure to display the SBA Quality Protocol Posters for Sub-district level health facilities (below DH level) and protocol posters from FRU to Medical College.
New FMR Old Budget Head Unit Cost Quant Amount Remarks Code FMR (Rs.) ity/Tar Approved Code get (Rs. in Lakhs) 16.1.4.1.1 A.1.3.3 JSY _ 2.91 As per JSY Administrative guideline Expenses
U.16 2.91 Programme Management
U17 IT Initiatives for Strengthening Service Delivery -NIL
U18 Innovations (if any)- NIL
Summary of Approvals- 2020-21; Maternal Health: District Tehri
FMR Code Budget Head Total Amount Approved (INR in Lakhs ) U.1 Service Delivery - Facility Based 60.26
U.2 Service Delivery - Community Based 9.86
U.3 Community Interventions 18.32
U.6 17.97 Procurement U.9 Training & Capacity Building 4.41
U.10 Review, Research, Surveillance & Surveys 0.13
U.11 0.00 IEC/BCC U.12 1.48 Printing U.16 2.91 Programme Management Total 115.34
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Chapter 2 Child Health Programme
The Child Health programme under the Reproductive, Maternal, Newborn, Child and Adolescent (RMNCH+A) Strategy of the National Health Mission (NHM) comprehensively integrates interventions that improve child health and nutrition status and addresses factors contributing to neonatal, infant, under-five mortality and malnutrition. The National Population Policy (NPP) 2000, the National Health Policy 2002, Twelfth Five Year Plan (2007-12), National Health Mission (NRHM - 2005 – 2017), Sustainable Development Goals (2016-2030) and New National Health Policy, 2017 have laid down the goals for child health.
Indicator Uttarakhand India Source
Infant Mortality Rate (IMR) 31 32 SRS 2018
Descriptions –
Infant Mortality Rate (IMR)- is the number of deaths of infants under one year old per 1,000 live births.
Neonatal Mortality Rate (NMR)- is the number of deaths during the first 28 completed days of life per 1,000 live births in a given year or period. Neonatal deaths may be subdivided into early neonatal deaths, occurring during the first seven days of life, and late neonatal deaths, occurring after the seventh day but before the 28 completed days of life.
Thrust Areas Under Child Health Programme
Thrust Area 1 : Neonatal Health
Essential new born care (at every ‘delivery’ point at time of birth) Facility based sick newborn care (at FRUs & District Hospitals) Home Based Newborn Care (HBYC) Home Based Newborn Care and Home Based Young Care (HBYC) Programme. Kangaroo Mother Care Breast Feeding Week
Thrust Area 2 : Nutrition Promotion of optimal Infant and Young Child Feeding Practices under Mother’s Absolute Affection (MAA) Programme Micronutrient supplementation (Vitamin A, Iron Folic Acid) Management of children with severe acute malnutrition National Deworming Day (NDD)
Thrust Area 3: Management of Childhood Diarrhoeal Diseases & Acute Respiratory Infections Intensified Diarrhoea Control Fortnight (IDCF)
Thrust Area 4:
Intensification of Routine Immunization
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Eliminating Measles and Japanese Encephalitis related deaths Polio Eradication
U.1 SERVICE DELIVERY (FACILITY BASED)-
NBCC (New born Care unit)-is a space with in the delivery room in any health facility where immediate care is provided to all newborn at birth. NBSU (New born stabilization unit)-is a facility within or close proximity of maternity ward where sick and low birth weights newborns can be cared.
SNCU (Special Newborn care unit)-is a neonatal unit in the vicinity of labour room which will provide special care (all except assisted ventilation and major surgery) for sick newborns.
A. For SNCU,NBSU and NBCC - The Amount is approved for the running cost of consumables (list of consumables as per the toolkit for setting up Special Care New-born Units and New-born Care Corners, UNICEF and Facility Based New-born Care guide, MoHFW 2011) and maintenance cost and it does not include the salaries.Budget could also be utilized for printing of the formats, stationary, internet broadband connection for SNCU online software. Telephonic connection for follow-up of the discharged child (dedicatedly for data entry operator working under SNCU).
B. Nutritional Rehabilitation Centre (NRC)- Nutritional Rehabilitation Centre (NRC)- It is a unit in a health facility where children with severe malnutrition (SAM) are admitted and managed. For Implementation for the same refer the Operational Guidelines on Facility Based Management of Children with Severe Acute Malnutrition, MoHFW, 2011
New Old Budget Unit Quantity Amount Remarks FMR FMR Head cost(Rs Target Approved code code in Lakhs) (Rs in Lakhs) Amount of Rs1.00 Lakh is approved as Operating 1.3.1.1. A.2.2.1 SNCU 1 1 1.00 cost for SNCU as per FBNC guidelines Approved as Operating 1.3.1.2 A.2.2.2 NBSU 0.15 3 0.45 cost for NBSUs as per FBNC guidelines Amount of Rs 1.40 Lakh is approved as Operating 1.3.1.3 A.2.2.3 NBCC 14 1.40 cost for NBCCs as per FBNC guidelines Amount of Rs 0.72 Lakh is approved as Operating cost for NRCs SDH 1.3.1.4 A.2.5 NRCs 0.72 1 0.72 Narender nagar as per Nutritional Rehabilitation Centres guidelines Total 3.57
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U.3 COMMUNITY INTERVENTION ANNEX
‘MAA’(Mothers’ Absolute Affection) Programme- in an attempt to bring undiluted focus on promotion of breastfeeding, in addition to ongoing efforts through the health systems. District to ensure ASHA incentive for MAAprogramme is provided for all 3 quarters for conducting 6-8 Village level meetings per quarter.
Incentive to ASHA for follow up of SNCU discharge and low birth babies- In cases when a newborn is discharged from SNCU, ASHAs are eligible to full incentive amount of Rs.250 forcompleting the remaining visits. In addition, ASHAs are also eligible for an incentive of Rs. 50 per visit per quarter for follow up of low birth weight babies and newborns discharged from SNCU. The low birth weight babies are followed up for two years andSNCU discharged babies for one year. Refer the HBNC guidelines for the same.
Incentive for National Deworming Day(NDD) - The objective of NDD is to deworm all preschool and school-age children between the ages of 1-19years through the platform of schools and anganwadi centers in order to improve their overall health,nutritional status, access to education and quality of life. To implement the same Incentive of Rs. 100 is given to ASHAs for mobilizing and ensuring everyeligible child (1-19 years out-of-school) is administrated Albendazole.
Incentive for IDCF (Intensified Diarrhea Control Fortnight)-The overall objective of IDCF is to ensure high coverage of ORS and Zinc use rates in children with diarrhoea throughout the country. Every ASHA would be provided an incentive of Rs. 1 per ORS packet distributed to a family with under five children.
New FMR Old FMR Budget Head Unit cost Quantit Amount Remarks code code y Approved Target Amount of Rs3.17 Lakh is approved. District to ASHA incentive ensure ASHA under MAA incentive for B1.1.3.2 programme @ Rs MAAprogramm 3.1.1.1.2 0.0030 1056 3.17 .6 100 per ASHA for e is provided for quarterly mother's all 3 quarters meeting for conducting 6-8 Village level meetings per quarter
3.1.1.1.5 B1.1.3.2 Incentive for Approved for .4 referral of SAM ASHA incentive cases to NRC 0.0015 148 0.22 for referral and and for follow up 4 follow-ups of of discharge SAM NRC
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children from discharged NRCs children 3.1.1.1.6 B1.1.3.2 Incentive for Approved for .7 National incentive to Deworming Day ASHAs@100 0.002 1056 2.11 for mobilizing out per ASHA per of school children Round for 1056 ASHAs 3.1.1.1.7 B1.1.3.2 Incentive for Amount .8 IDCF for approved for prophylactic distribution of distribution of ORS @1 per 0.779 1 0.78 ORS to family ORS packet with under-five delivered to children. family under five children Approved for incentive @ Rs. National Iron Plus 100 per ASHA incentive for per month for mobilizing mobilizing children and/ or children and 3.1.1.1.9 0.006 1056 6.34 ensuring ensuring compliance and compliance and reporting (6-59 reporting for months) IFA Syrup of age group of 6- 59 months. Total 12.62
U.6 PROCUREMENT
JSSK – JananiShishuSurakshaKaryakram – Entitlement for Sick Newborn till 1 year of ageare:-
1. Free and Zero Expense treatment 2. Free Drugs and Consumables 3. Free Diagnostics 4. Free provision of blood 5. Free transport form home to institution 6. Free transport between facilities in case of referral 7. Drop back from institutions to home 8. Exemptions from all kinds of user charges
Refer the guidelines for Implementation of JSSK.
District must provide for all JSSK entitlement schemes mandatorily. No beneficiary shall be denied any entitlement because of cost estimates/any other reason. If there are variations in cost., it must be examined and ratified by the RKS. JSSK approval is subject to ensuring that there is no duplication under free drugs and diagnostic initiative under NHM.
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New Old Budget Head Unit Quantity Amount Remarks FMR FMR cost(Rs Target Approved code code in (Rs in Lakhs) Lakhs) Approved Rs 0.76 lakhs for JSSK drugs JSSK drugs and B.16.2. 6.2.2.1 and 0.002 380 0.76 consumables for 2.1 consumables 380 sick children @200 per beneficiary Approved Rs Free 073 lakh for Diagnostics for 6.4.4 A.2.9.1 0.0005 1460 0.73 1460 sick Sick infants infants@ 50 per under JSSK beneficiaries Total 1.49
U.7 REFERRAL TRANSPORT
New Old Budget Head Unit Quantity Amount Remarks FMR FMR cost Target Approved code code (Rs in Lakhs) 7.2 Free Referral - 150 - Amount approved Transport - for 150 number of JSSK for Sick pick-up of sick Infants infants (0-1 years) Budget will be released to the service provider from State Headquarter (NHM).
U.8 SERVICE DELIVERY- HUMAN RESOURCE
U.9 TRAINING AND CAPACITY BUILDING
New Old Budget Head Unit Quantit ROP Remarks FMR FMR cost (Rs y Target Approval code code in lakh) (Rs in Lakhs) Orientation on Approved for IDCF 9.5.2.2 A.2.6 IDCF/ ARI 0.0005 1300 0.65 orientation (Pneumonia)
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State and District 9.5.2.2 1 0.50 Approved. Launch of IDCF Orientation training Approved for training 9.5.2.3 on Anemia mukt - 1 0.52 of MO, SNs, bharat Program BCM,AF etc Training conduct with MDR. Child Death Review 9.5.2.4 - - - Trainings
Budget approved for Half day orientation on NDD for 2 rounds @ Rs 100/- per participant and A.9.5 Orientation on integrated 9.5.2.19 .5.2. National 0.001 5128 5.13 distribution of drug, d Deworming Day IEC and training material to teachers (Government schools, Private schools) and ANMs. One day orientation Approved for one of Frontline workers day orientation of and allied 9.5.2.23 0.001 1605 1.61 ASHAs, AF, ANMs. departments under AWW, teachers and Anemia mukt bharat allied departments. Total 8.40
U.10 REVIEW, RESEARCH, SURVEILLANCE AND SURVEYS
Child Death Review- Child Death Review (CDR) is a strategy to understand the geographical variation in causes of child deaths and thereby initiating specific child health interventions. Analysis of child deaths provides information about the medical causes of death, helps to identify the gaps in health service delivery and social factors that contribute to child deaths.
The Chief Medical Officer (CMO) is mainly responsible for the Child Death Reviews at the District level. Both facility and community based reviews from rural and urban areas would be taken up at this level. Refer the guidelines (Child Death Review) for Implementation of CDR and process of CDR reporting
New Old Budget Unit Quantity Amount Remarks FMR FMR Head cost Target Approved code code (Rs in (Rs in Lakhs) Lakhs) Approved for CDR Child incentive. District to follow 10.1.2 A.2.8 Death - - 0.10 CDR guidelines for Review incentives. Total 0.10
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U.11 IEC/BCC- Refer IEC ROP
U.12 PRINTING
New Old Budget Head Unit Quantity ROP Remarks FMR FMR cost(Rs Target Approval code code in Lakhs) (Rs in Lakhs) 12.2.3 Anemia T3 Camps 0.05 36 1.80 Budget (Printing for approved for Micronutrient Anemia T3 Supplementation Camps in Programme schools and including IEC Slum areas @ materials, Rs. 5000 per reporting formats, camp as per guidelines / AMB T3 training materials guideline. etc. (For AMB and Vitamin A supplementation programme) 12.2.4 A.2.8 Printing of Child 0.01 9 0.09 Amount Death Review approved for formats Printing of Child Death Review formats 12.2.7 B.10.7. Printing of IEC 0.14 6 0.84 Amount 4.8 Materials and approved for IEC monitoring formats and printing of for IDCF forms for IDCF. Total 2.73 U.16 PM SUB ANNEXURE- NIL
SUMMARY OF APPROVALS
FMR Budget Head Total Amount Approved (Rs in Lakh) U.1 Service Delivery - Facility Based 3.57 U.3 Community Interventions 12.62 U.6 Procurement 1.49 U.9 Training & Capacity building 8.40 U.10 Review, Research, Surveillance & Surveys 0.10 U.11 IEC/BCC --- U.12 Printing 2.73 U.16 Programme Management sub annexure 0.0 Total 28.91
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Chapter 3 Family Planning
In Uttarakhand, the TFR has decreased by 0.2 points from 2.1(SRS 2014) to 1.9 (SRS 2016).
State’s current contraceptive prevalence rate is 53.4% (NFHS 2015-16) which show a decline in comparison to NFHS 2005-06 (59.3%).
Unmet need is 15.5% (NFHS 2015-16) which show a decline in comparison to NFHS 2005-06 (12.3%).
Decline in contraceptive prevalence rate & Unmet need points out that eligible couples are not getting family planning services.
District to ensure of Availability of all family Planning Commodity & PTK at all health facility, and made sure all eligible couples are properly counselled to adopt right family planning commodity according to their need.
OBJECTIVES OF FAMILY PLANNING PROGRAMME
Population Stabilization
• spacing method (IUCD, Oral Contraceptive Pills, Condoms, Injectable Contraceptive DMPA )
• limiting method (Laparoscopic, Minilap, NSV)
• Maintain TFR by increase in contraceptive prevalence rate
• Promote Reproductive Health
• Increase contraceptive prevalence rate STRATEGY-WISE INTERVENTIONS
• Focus on spacing methods, particularly PPIUCD, at facilities with high number of deliveries. As per direction of GOI PPIUCD ratio to No Of delivery should be 20-25%. • Focus on interval IUCD at all facilities including sub centres. • Ensuring access to Pregnancy Testing Kits (PTK-”Nischay Kits”) through ASHA’s. • Ensure permanent sterilization services at PHC, CHC, SDH and DH on fixed days, with aiming static service delivery at DHs & Identified CHCs. • Maintaining Quality in Family Planning services by strengthening the QACs as well as refresher training to service providers. • Regular training schedules for service providers. • Facilitating and encouraging empanellement of private providers. • Increase the number of service provider’s for IUCD, PPIUCD, NSV and LTT/Minilap. • Monitoring and evaluation of Family Planning Services at District and Block Level. • Ensuring supply and stock of essential provisions at all levels/facilities using FP-LMIS • Strengthen Home Distribution of Contraceptives Scheme & Ensure Availability of Contraceptive with ASHA. • Roll out of Injectable Contraceptive across all health facilities in District.
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Service Delivery - Facility Based
New Old Budget Head Unit Quantity/ Budget Remark FMR FMR Cost Target (Rs. (Rs) Lakhs) 1 Service Delivery - 28.8 Facility Based In New FMR Code 1.1.3.1.1& 1.1.3.1.2 District should communicate a fixed day of a month when sterilisation service will be available in a particular health facility. Dispersed amount can be spend on Transport for service provider team (As per actual/entitlement), POL/transport for accepters, contingency& IEC 1.1.3.1.1 A.3.1.1 Female sterilization 3000 27 0.81 Approved Rs fixed day services 0.81 lakhs for 27 Female sterilization Fixed day services@ Rs. 3,000/- per fixed day service 1.1.3.1.2 A.3.1.2 Male Sterilization fixed 25000 1 0.25 Approved Rs. day services 0.25 lakhs for 1 male sterilization Fixed day services@ Rs. 25,000/- per fixed day service
In New FMR Code 1.2.2.1.a & 1.2.2.1.b compensation to be given as per Government order no. 312/XXVIII-4-2015-75/2013 dated 21 February 2015 passed in the state of Uttarakhand.
1.2.2.1.1 A.3.1.3 Compensation for 2000 1105 22.10 Approved Rs. female sterilization 22.10 lakhs for (Provide breakup for 1105 Female cases covered in public sterilization @ facility, private facility. Rs. 2,000/- Enhanced compensation Compensation Scheme per Female (if applicable) sterilization. additionally provide number of PPS done. Female sterilization done in MPV districts may also be budgeted in this head and the break up to be reflected) 1.2.2.1.2 A.3.1.4 Compensation for male 2700 61 1.647 Approved Rs. sterilization/NSV 1.647 lakhs for (Provide breakup for 61 male cases covered in public sterilization @ facility, private facility. Rs. 2,700/- Male sterilization done compensation in MPV districts may per male also be budgeted in this sterilization. head and the break up to be reflected)
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For Adopting PPIUCD & PAIUCD the beneficiary will be paid compensation of Rs. 300/- to cover their incidental & travel cost to enable them to come for follow up. The PAIUCD incentive is only payable for PAIUCD insertion following induced (surgical) or spontaneous abortions and not for the medical methods of abortions (MMA).
1.2.2.2.2 A.3.2.3 PPIUCD services: 300 1178 3.534 Approved Rs Compensation to 3.534 lakhs beneficiary@Rs PPIUCD 300/PPIUCD insertion Compensation @ Rs. 300/- per Client for 1178 PPIUCD Insertion. 1.2.2.2.3 A.3.2.4 PAIUCD Services: 300 153 0.459 Approved Rs. Compensation to 0.459 lakhs beneficiary@Rs 300 per PPIUCD PAIUCD insertion) Compensation @ Rs. 300/- per Client for 153 PAIUCD Insertion. 1.2.2.3 A.3.6 Family Planning 30000 As per Will be which Beneficiary Indemnity Scheme list shared will be paid shared in compensation in by state future this Financial in future Year 2020-21 will be communicated by state as per the availability of fund
Service Delivery - Community Based
Unit Budget New Old Quantity/ Budget Head Cost (Rs. Remark FMR FMR Target (Rs) Lakhs) Service Delivery - 2 0.60 Community Based POL being given to Tehri district @60000 which includes quarterly collection of Family Planning supply from CMSD store Dehradun & supply of Family Planning commodity from District store to health facility on quarterly basis. This also include labour cost of loading & unloading charges POL for Family Planning/ Others Approved 0.60 2.2.1 A.3.3 (including additional 60000 0.60 lakhs. mobility support to surgeon's team if req)
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Community Interventions
Unit Budget New Quantity/ Old FMR Budget Head Cost (Rs. Remark FMR Target (Rs) Lakhs) Community 3 7.6465 Interventions Rs 150 may be paid to ASHA for motivating/escorting the clients to the health facility for facilitating the PPIUCD & PAIUCD insertion
ASHA PPIUCD incentive Approved Rs. for accompanying the 1.767 lakhs 3.1.1.2.4 B1.1.3.3.1 client for PPIUCD 150 1178 1.767 @Rs.150 insertion (@ Rs. incentive for 150/ASHA/insertion) ASHA ASHA PAIUCD incentive Approved Rs. for accompanying the 0.2295 lakhs 3.1.1.2.5 B1.1.3.3.2 client for PAIUCD 150 153 0.2295 @Rs.150 insertion (@ Rs. incentive for 150/ASHA/insertion) ASHA Approved Rs ASHA incentive under 4.05 lakhs ESB scheme for 3.1.1.2.6 B1.1.3.3.3 500 810 4.05 @Rs.500 promoting spacing of incentive for births ASHA ASHA Incentive under Approved Rs. ESB scheme for 1.60 lakhs 3.1.1.2.7 B1.1.3.3.4 promoting adoption of 1000 160 1.60 @Rs.1000 limiting method up to two incentive for children ASHA
Untied Fund -NIL
Infrastructure-NIL
Procurement
Unit Budget New Old Quantity/ Budget Head Cost (Rs. Remark FMR FMR Target (Rs) Lakhs) Maximum permissible amount for repair of 1 laparoscope is Rs. 25000. district need to request demand Repairs of 6.1.3.1.1 A.3.4 25000 to state through Laparoscopes proper channel, so it can be approved at state level & thus release to district as per availability of fund
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Referral Transport
Unit Budget New Quantity/ Old FMR Budget Head Cost (Rs. Remark FMR Target (Rs) Lakhs) 7 Referral Transport 0.7675 For cases performed on a fixed day basis vehicle like ambulances/alternate vehicle could provide drop back to 1-4 clients at a time. such vehicle could be employed for multiple trips ferrying the cases depending on the time of their surgery For post-partum sterilisation conducted on the clients while still in the hospital following delivery, no separate vehicle would be required. The existing facility of ‘khushiyon ki sawari’ designated for drop back of mothers and new born babies may be used. Drop back scheme Approved Rs 0.7675 7.3 B12.2.9.1 for sterilization 250 307 0.7675 lakhs for Scheme clients @250 per client
Service Delivery - Human Resources
Unit Budget New Old Quantity/ Budget Head Cost (Rs. Remark FMR FMR Target (Rs) Lakhs) 8 Human Resources 3.2237 Incentives and 8.4 Allowances
Incentives for service provider for Providing IUCD @Rs 20, PPIUCD@Rs 150 & PAIUCD @Rs 150 service
Incentive to provider for Approved Rs. IUCD insertion at health 1.2272 lakhs facilities (including fixed @Rs.20 8.4.6 A.3.2.2 day services at SHC and 20 6136 1.2272 incentive for PHC) [Provide breakup: Service Public Sector (@Rs. Provider 20/insertion] Approved Rs. Incentive to provider for 1.767 lakhs PPIUCD services @Rs @Rs.150 8.4.7 A.3.2.3 150 1178 1.767 150 per PPIUCD incentive for insertion Service Provider Approved Rs. Incentive to provider for 0.2295 lakhs PAIUCD Services @Rs @Rs.150 8.4.8 A.3.2.4 150 153 0.2295 150 per PAIUCD incentive for insertion Service provider
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Training & Capacity building
Unit Budget New Quantity/ Budget Head Cost (Rs. Remark FMR Target (Rs) Lakhs) 9 Training 1.87 9.5.3 Family Planning Trainings Approved Rs 0.54 Orientation/review of lakh for ANM/AWW (as applicable) Orientation/review of for New schemes, FP- ASHA/ANM/AWW at LMIS, new contraceptives, block level i.r.t New Post partum and post Contraceptives, Post- abortion Family Planning, 9.5.3.1 3000 18 0.54 partum and post Scheme for home delivery of contraceptives (HDC), abortion Family Ensuring spacing at birth Planning, Scheme @ (ESB {wherever Rs. 3000/- per applicable}), Pregnancy meeting for 18 Testing Kits (PTK) meetings (twice a year for 9 blocks) Budget approved for Training of 1 batch Training of Medical officers comprising of 10 MO 9.5.3.22 (Injectible Contraceptive 42800 1 0.428 per batch@ Rs. Trainings) 42,800/- Per batch. Details of budget attached Training of Nurses (Staff Training of 15 SN 9.5.3.24 Nurse/LHV/ANM) (Injectible 40230 1 0.402 per batch@ Rs. Contraceptive Trainings) 40,230/- Per batch. Training of health facility which are not 9.5.3.26 FP-LMIS Training 50000 1 0.50 trained in FP-LMIS plus ANM of Sub- center and ASHA
Review, Research, Surveillance & Surveys- NIL
IEC/BCC
Unit Budget New Old Quantity/ Budget Head Cost (Rs. Remark FMR FMR Target (Rs) Lakhs) 11 IEC/BCC 0.80 IEC/BCC activities 11.6 under FP IEC & promotional Amount Approved 11.6.3 A.3.5.4 activities for World 50000 1 0.50 Rs 0.50 Lakhs Population Day regarding IEC &
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celebration Promotional activities for World Population Day celebration Amount Approved Rs 0.30 Lakhs regarding IEC & IEC & promotional Promotional 11.6.4 A.3.5.5 activities for Vasectomy 30000 1 0.30 activities for Fortnight celebration Vasectomy Fortnight Celebration
Printing -NIL
Quality Assurance - NIL
Drug Warehousing and Logistics -NIL
PPP - NIL
Programme Management
Programme Management Sub Annexure
Unit Budget New Old Quantity/ Budget Head Cost (Rs. Remark FMR FMR Target (Rs) Lakhs) Programme 16 Management Sub 2.55 Annexure
As per supreme court mandate District quality assurance committee & District indemnity sub Committee to be held on Quarterly basis at district
FP QAC meetings (Minimum frequency of Approved Rs 0.20 QAC meetings as per lakh per quarterly A.3.5.1 Supreme court mandate: meeting at district State level - Biannual level @5000 per meeting; District level - meeting Quarterly) 5000 4 0.20
District:
PM activities for World Population Day’ celebration (Only mobility Approved to be met A.3.5.4 cost): funds earmarked out of PM cost for district level approved under activities 30000 1 0.30 F.M.R. code 16.1 PM activities for Approved to be met A.3.5.5 Vasectomy Fortnight out of PM cost celebration (Only mobility 25000 1 0.25 approved under
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cost): funds earmarked F.M.R. code 16.1 for district level activities
Block:
PM activities for World Approved RS. 0.90 Population Day’ lakhs @10000 per A.3.5.4 celebration (Only mobility block for World cost): funds earmarked Population day for block level activities 10000 9 0.90 celebration PM ativities for Approved RS. 0.90 Vasectomy Fortnight lakhs @10000 per A.3.5.5 celebration (Only mobility block for Vasectomy cost): funds earmarked Fortnight for block level activities 10000 9 0.90 celebration
IT Initiative for Strengthening service delivery -NIL
Innovations - NIL
Summary of Approvals : Family Planning - Tehri
FMR Budget Head Total Amount Approved
U.1 Service Delivery - Facility Based 28.8
U.2 Service Delivery - Community Based 0.60
U.3 Community Interventions 7.6465
U.7 Referral Transport 0.7675
U.8 Service Delivery - Human Resources 3.2237
U.9 Training & Capacity building 1.87
U.11 IEC/BCC 0.80
U.16 Programme Management 2.55
Total 46.2587
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Chapter 4 Rashtriya Kishore Swasthya Karyakram (RKSK)
Adolescents (253 million) comprise nearly one-fifth (22 percent) of India’s total population (Census 2011). Of the total adolescent population, 12 percent belong to the 10-14 years age group and nearly 10 percent are in the 15-19 years age group. Adolescence is a very promising phase of life. Government of India recognizes the need to provide the best possible support and care to adolescents in the country so that they realize their full potential in life. Compulsory education at least up to 14 years of age, opportunities for higher education al skills, access to health care and protection from coercion or violence are some ways in which our government is committed to provide an enabling environment for adolescents. Our constitution grants its children some special rights and to meet these rights, Government of India has brought in several policies, programmes, schemes and legal acts to protect and promote their health and well – being. The health and well – being of the adolescent population is a key determinant of any country’s overall development. Supporting adolescents in reducing barriers to access education, health and opportunities for growth and development will help India realize its demographic bonus, as healthy adolescents are an important resource for the economy. The Adolescent Health Strategy is one such initiative in this direction. The adolescent health strategy has six priorities:
1. Sexual and reproductive health 2. Mental and emotional well-being 3. Healthy lifestyle 4. Violence-free living 5. Improving nutritional status 6. Substance misuse prevention.
1.Service Delivery Facility Based
Activity ; Counseling Services to adolescents are to be provided in All Adolescent friendly health clinics (AFHC) , as per guidelines (annexure in email). These AFHC s should be open on all working days of week in Medical College and District Hospitals. Since these facilities have male and female counselors, one of them should manage AFHC at facility while other can do so in field in two working days per week.
In AFHCs located at CHC /PHC counseling services are to be provided at facility for at least 4 working days per week. Counselor will make field visit for counseling in field (either community or school) for two days in a week .
New Old FMR Budget Head Unit Qnty Amount Remark FMR Code cost Approved Code Rs. In Lakh 1.1.4 Strengthening AH 0 0 0 Service
1.3.1.6 A.4.1.3 AH/RKSK Clinics 1000 10 1.0 Approved total Operating Cost 0 10. Existing AFHC@10000 /-Per Clinic
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2.Service Delivery Community Based Adolescent Health days (AHD) to be organized in every village once every quarter, as per guidelines (annexure in email).Total 500 AHD are to be organised by District and 820 Club meeting will be organised by ANMs Sub center 2.2.2 A.4.1.4 Mobility & 250 96 2.88 1.Mobility Communication Visit support for AH Support for Counselors /AFHC Counsellors s total @Rs.200/-Per 1152 visit Visit (maximum 8 For 12 visits per couns month) X elors 10AFHC, 2.Communicat ion support for AFHC counselors @Rs 250/cunsellor X12 months. 3. Mobility support to District RKSK Coordinator. @Rs.350/-Per Visit (maximum 8 visits permitted.) 2.3.1.5 A.4.2.2 Organising Adolscent 2500 600 15 2500/-Per Health day AHD X 600 AHD 2.3.1.6 A.4.2.3 Organising Adolscent 500 800 4.00 Rs.500/- Per Friendly Health Clincs club meeting at Sub Center Level for 800 Club meeting. Community Intervention Incentive for AH/RKSK Services Each Peer Educator gets Rs.600 worth any gift (non Monetary) which they can use and ASHA get Rs 200/-incentive Per AHD organized. 3.1.1.3.2 B.1.1.3.4. Incentive for Mobilizing 200 60 1.2 Approved For 2 Adolescent and 0 mobilizing Community to AHD beneficiaries for 600 AHD 3.2.2 A.4.2.1 Incentive for Peer 50/- 18 9.0 Approved for Educators 00 non monetary 0 incentive for 1500 existing
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PE:@Rs 50 per PE per Month 4.1 Untied Funds 0 0 0 0 5.2.1.9 A.4.1.2 Infrastructure 0 0 0 0 6.1.1.4 Procurments of bio medical Equipment 6.1.14.a B.16.1.6.1 Equipment of AFHC 0 0 0 0 6.1.14.b B.16.1.6.2 Any Other (Please 0 0 0 Approved for 6 Specify) RKSK District for a set of Sanitary Napkins vending Machine and Incinirator for District Govt Girls School Drug Procurements 6.2.4.1 B.16.2.6.3 IFA /WIFS (10-19Yrs) State Procurements a 6.2.4.2 B.16.2.6.3 Albendazole Tab under State Procurements b WIFS (10-19Yrs) 6.2.4.3 B.16.2.9.1 Sanitary Napkins State Procurements Procurement 7 Referral Transport 0 0 0 0 8 Human Resource 8.1.1.3.1 B.30.11.1 Counselors 0 0 0 0
9 Trainings 9.5.4.1 Dissemination 0 0 0 0 workshop under RKSK 10 Review,Resurch,Surv eys and Survilance 10.1.1 0 0 0 0 11 IEC/BCC 11.7.1 B.10.3.4.1 Media mix of Mass 0 0 0 0 Media,Mid media including menstrual hygiene Scheme 11.7.2 B.10.3.4.2 Inter personal 0 0 0 0 communication 12 Printing 12.4.1 A.4.2.4 PE Kit PE Diary 0 0 0 0 13 Quality Assurance 14 Drug Ware housing & 0 0 0 0 Logistic
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15 PPP 0 0 0 0 16 Program Management 0 0 0 0 16.8.2.1. P.O. RKSK 0 0 0 0 2 17 I T Initiative and 0 0 0 0 Strengthening Service Delivery 18 Innovation 0 0 0 0
Summary of Approvals-2019-20 ; RKSK-Tehri. FMR Code Budget Head Total Approved (INR In Lakhs )
U.1 Service Delivery - Facility Based 1.0 U.2 Service Delivery - Community Based 21.88 U.3 Community Interventions 10.20
U.6 Procurement .26- U.9 Training & Capacity Building 70.20. Total 103.54
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Chapter 5 RBSK & Haemoglobinopathy
Rashtriya Bal Swasthya Karyakram (RBSK) is aimed at screening of children from 0 to 18 years for 4 Ds - Defects at birth, Diseases,Deficiencies and Development Delays including Disabilities in Uttarakhand. As per available estimates, 6% of children are born with birth defects, 10% children are affected with development delays leading to disabilities. Further, 4% of under five mortality and 10% of neonatal mortality is attributed to birth defects.
Child Health Screening and Early Intervention Services envisage to cover 30 identified health conditions for early detection, free treatment and management through dedicated mobile health teams placed in every block in the country. The teams carry out screening of all children in the pre-school age enrolled at Anganwadi centres at least twice a year besides screening of all children studying in Government and Government aided schools, whereas the newborns will be screened for birth defects in health facilities by service providers and during the home visits by ASHAs. District Early Intervention Centres are planned to be set up as first referral point for further investigation, treatment and management. Tertiary care centre would be roped in for management of complicated cases requiring high-end medical care and treatment. This herculean effort is ultimately targeted to benefit children annually in a phased manner in Uttarakhand.
Needless to say, that dividends of early intervention would be huge including improvement of survival outcome, reduction of malnutrition prevalence, enhancement of cognitive development and educational attainment and overall improvement of quality of life of our citizens. Bringing down both out of pocket expenses on belated treatment of diseases / disabilities (many of which become highly debilitating and incurable) and avoidable pressure on health system on account of their management are among obvious benefits.
Children diagnosed with illnesses shall receive follow up including surgeries at tertiary level, free of cost under RBSK. Rashtriya Baal Swasthya Karyakram is being implemented in 13 districts of Uttarakhand. Under this programme the children taking birth in government hospitals, children enrolled in government and government aided schools and anganwadi from age of 0 to 18 years are covered. These children are screened for selected health conditions by 139 Mobile Health Teams (MHTs).
For confirmation of preliminary findings, referral support, management & follow up of screened children for which four early intervention centres are established in Almora, Dehradun, Haridwar, Nainital. DEIC is the hub of all activities, will act as a clearing house and also provide referral linkages. DEIC should be aiming at early detection and early intervention so as to minimize disabilities among growing children. WHO has stated that defect or developmental delay leads to functional disability and these functional disability in turn lead to handicap if not addressed adequately.
Government of India has provided Guideline “Procedure and Model Costing for Surgeries” for the treatment of these children & treatment is provided to these children on the basis of this guideline.
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RoP approvals for RBSK
U1. Service Delivery (Facility Based) New Old FMR Particulars Unit Quantity/ Budge State FMR Cost Target t (Rs. Remarks (Rs.) Lakhs) 1 Service Delivery - Facility 0 Based 1.1.2 Strengthening CH 0 Services 1.1.2. A.5.1.6 New born screening as per NIL 2 RBSK Comprehensive Newborn Screening: Handbook for screening visible birth defects at all delivery points (please give details per unit cost , number of deliveries to be screened and the delivery points Add details) 1.1.2. A.5.2 Referral Support for NIL 3 Secondary/ Tertiary care (pl give unit cost and unit of measure as per RBSK guidelines) - RBSK 1.1.7 Strengthening Other 0 Services 1.1.7. Any other (please specify) NIL 7 1.3 Operating Expenses 0 1.3.1 Operating expenses for 0 Facilities (e.g. operating cost rent, electricity, stationary, internet, office expense etc.) 1.3.1. A.5.1.4/ NIL 7 B16.1.6.3. 5
U2. Service Delivery (Community Based) New Old Particulars Unit Cost Quantity Budget State Remarks FMR FMR / Target (Rs) (Rs. Lakhs) 2 Service Delivery - 54.8006 Community Based 4 2.2 Recurring/ 54.8006 Operational cost 4
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2.2.3 A.5.1.3 Mobility support for Rs 51.48864 lakhs is RBSK Mobile 396066 13 51.4886 approved as per detail health team 4 below: Rs 50.76864 lakhs for 12 vehicles one per team @ RS
35256 per month for 12 months. Rs 0.72 lakhs is for mobility support @ Rs 6000 per month for 1 RBSK district manager for 12 months. 2.2.4 B16.1.6. Support for RBSK: 1.44 Lakhs is 3.6 CUG connection approved for Data per team and rental card @ Rs 1000 for 13476.92 13 1.752 12 mobile health teams for 12 months. 0.312 Lakhs is approved for 13 CUG connection to the 12 MHTs, 1 District RBSK Managers 2.2.1 A.5.1.7 Any other (please 12000 13 1.56 lakhs is 1 specify) approved for contingency @ Rs
1000 for 12 teams 1.56 and 1 RBSK Manager.
U3. Community Interventions - - - - U4. United Fund - - - -
U5. Infrastructure Strengthening New Old Particulars Unit Quantity/Target Budget State Remarks FMR FMR Cost (Rs. (Rs.) Lakhs) 5 Infrastructure 0 5.2.2 B5.1/ Carry forward 0 B5.2/ of new B5.3/ construction B5.6/ initiated last B5.5/ year, or the B5.10/ year before B.5.11/ B.5.12/ B.5.13 5.2.2.7 B.5.13.2 DEIC (RBSK) NIL
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U6. Procurement New Old FMR Particulars Unit Quantity/ Budget State Remarks FMR Cost Target (Rs. (Rs.) Lakhs) 6 Procurement 0. 60 6.1 B.16.1 Procurement of 0. 60 Equipment 6.1.1 Procurement of 0. 60 Bio-medical Equipment 6.1.1.5 B16.1.6.3 Procurement of 0.60 bio-medical equipment: RBSK 6.1.1.5 B16.1.6.3 Equipment for 5000 12 0.60 Approved for 12 .a .1 Mobile health teams teams @ average cost of Rs 5000 as proposed by State. Expenditure is as per actual and according to RBSK Job Aids each team to have all required equipment for screening. 6.1.1.5 B16.1.6.3 NIL .b .2 6.2.5 Drugs & supplies 0 for RBSK 6.2.5.1 B.16.2.7. Medicine for Mobile NIL 1 health team
U7. Refferal Transport - - - -
U8. Human Resources – Service Delivery Attached in Separate Chapter (Human Resource)
New Old Particulars Unit Quantity Budget State Remarks FMR FMR Cost /Target (Rs. (Rs.) Lakhs) 8 Human Resources - - - -
U9. Training & Capacity 0.69552 Building 9.5.1 Maternal Health 0.69552 Training 9.5.4 School Health 0.69552 .3.1 Programme 9.5.5 RBSK Training – Traing 69552 1 0.69552 Rs. 0.69552 Lakhs .1 of Mobile health team – approvded for technical and refresher traing. managerial ( 5 days ) Expenditure is as per
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actuals and according to RC training norms. U10. Review, Research, - - - - Surveillance & Surveys U11. IEC/BCC - - - -
U12. Printing New Old FMR Particulars Unit Quantity/Target Budget State Remarks FMR Cost (Rs. (Rs.) Lakhs) 12 Printing 0 12.5 Printing 0 activities under RBSK 12.5.5 B.10.7.4.4 Printing cost for NIL DEIC
U13. Quality Assurance - - - - U14. Drug Warehousing and Logistics - - - - U15. PPP - - - -
U16. Programme Management Sub RBSK Convergence/Monitoring meetings as per norms. New Old Particulars Unit Quantity/T Budget State Remarks FMR FMR Cost arget (Rs. (Rs.) Lakhs) 16.1 Programme 0.4 Management 16.1.2.1 Meetings, 0.4 Workshops & Conferences 16.1.2. A.5.1.2 RBSK 20000 2 0.4 Approved for 1.7 Convergence/Monit workshops – 2 at oring meetings district level –@ Rs 20000/workshop as per norms. Expenditure as per actual.
Summary of Approvals: RBSK, Tehri Garhwal FMR Budget Head Amount ( In Lakhs) U.2 Service delivery – Community based 54.80064 U.6 Procurement 0.60
U.9 Training & capacity building 0.69552 U.16 Programme management 0.40 Total 56.49616
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Haemoglobinopathy
1. Service Delivery - Facility Based
Antenatal Screening : This activity includes Antenatal screening for carrier status (early 1st trimester) in all women by NESTROFT test and hemoglobin estimation. Any woman with a positive NESTROFT test or severe anemia needs to be referred to District hospital by 108 services for further investigations including CBC and HPLC. If she is found to be a thalassemia carrier, then her husband is to be tested for his carrier status.
Follow up fund for this activity is approved in FMR code 2.3.1.4 (Follow up mechanism for the severely anemic women and the women with blood disorders) which is informed to district when both Parents are found to be carriers & then referral to a higher centre is required for prenatal diagnosis before twenty weeks of pregnancy for an informed decision regarding continuation of pregnancy.
New Budget Head Unit Amount FMR Cost Physical being Remarks Code Target allocated for FY 2020-21 1.1.1.4 Antenatal Screening of all 105.05 610 0.64 pregnant women coming to the facilities in their first trimester for Sickle cell trait, β Thalassemia, Hemoglobin variants esp. Hemoglobin E and Anemia
Transfusion support to patient with Blood disorders and prevention program: This activity includes monitoring investigations and procurement of consumables (BT sets etc), Blood cell counter for CBC, NESTROFT, HbHPLC & Serum ferritin by ELISA before Blood transfusion of thalassemic patients.
New Amount being Remarks FMR Budget Head Unit Physical allocated for FY Code Cost Target 2020-21 (In Lakhs)
1.1.7.3 Transfusion support to - ___ - patient with Blood disorders and prevention program
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2 . Service Delivery (Community Based)
Mobility for Field Team: This activity includes mobility fund for Haemoglobinopathy teams for School screening of Class IX students to find carrier of thalssemia disease.
New Amount being FMR Budget Head Unit Physical allocated for Remarks Code Cost Target FY 2020-21 (In Lakhs)
2.1.3.3 Any Other ( Pls Specify) ______0.00 Approval Mobility Awaited Haemoglobinopathy from GOI One Time Screening: This activity includes Screening of adolescents group by Field Officer & Field Assistant of Haemoglobinopathy team in Government & Government aided school of Class IX students for finding the carrier of Thalassemia traits. Fund utilization includes procurement of reagents for Blood cell counter for CBC, NESTROFT, HbHPLC . FMR Unit Amount Code Budget Head Cost Physical being Remarks Target allocated for FY 2020-21
2.3.3.1 One time Screening to 23.69 5503 1.30 Identify the carriers of Sickle cell trait, β Thalassemia, Hemoglobin variants at school especially class 9 students
3. Community Interventions - NIL 4. Untied Fund - NIL 5. Infrastructure - NIL 6. Procurement
Drugs and Supplies for blood services and blood related disorder: This activity includes procurement of Leukocyte filter, Iron chelator medicines, Lab glassware and plastic ware, Lab disposables and miscellaneous chemical- Stains, acid, PH paper, lancet for the thalassemic patients who are registered in DEIC taking blood transfusion.
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Amount being New Unit allocated for FMR Budget Head Cost Physical FY 2020--21 (In Remarks Code Target Lakhs)
6.2.7.2 Drugs and Supplies for - ___ - blood services and blood related disorder- Haemoglobinopathies
7. Referral Transport - NIL 8. Service Delivery - Human Resource
HR is sanctioned for post of field Officer, Field Assistant, Pathologist.
New Old FMR Amount FMR Code Budget Head Unit Quantity being Remarks Code Cost allocated for FY 2020-21 (In Lakhs) 8.1.13.1 B.30.11.1 Field IEC Officer ___ 2 _ HR will cum Counsellor be shared – Hbpathy by HR 8.1.13.11 B.30.11.17 Field Assistant – __ 2 _ Division Hbpathy SPMU 8.1.2.6 B.30.2.7 Pathologist – ___ 1 _ separately ABD Total
9. Training & Capacity Building -
FMR Code Amount being Budget Head allocated for FY Remarks 2020-21 (In Lakhs) 9.5.6.2 Budget approved for one day 0.59 motivational training program regarding anemia, Thalasemmia, Hemophila and other blood disorders to train 50 participants per districts.
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10. Review, Research, Surveillance & Surveys - NIL 11. IEC/BCC Activities
FMR IEC/BCC activities Unit Cost Activity Budget Remarks Code under Blood approved disorders Observing the important days associated with 11.10.2 Thalassemia, Anemia, Hemophilia & Voluntary Blood Donation. Nukkad Natak/Folk 11.10.2 Show/Puppet Show Sensitization of 20,000.0 9 1.80 To sensitize the school School children & 0 children and community based youth among the youth on community in Anemia,Thalassemia,Haemop convergence with hilia &Voluntry Blood NYK,NSS,NCC,Civil donation.A workshop/seminar defence, Red cross will be conducted in each society, Urban/ block of districts in Rural, dev. Deptt., convergence with ICDS & NSS,NCC,Civil defence,Red 11.10.2 NGOs,social and cross society ,Urban/Rural relegious ,dev. Deptt.,ICDS & organization.(95- NGOs,social and religious Blocks) organizations(on going activity) The activity agenda and venue to be planned by the State/District hb pathy division. (Budget approved to sensitize 09 blocks @20000 per block).
12. Printing
FMR Printing of cards for Unit Activity Budget Remarks Code screening of children Cost approved for Haemoglobinopathies Printing of IEC/BCC 10.00 5000 0.50 A 10 page multi color 5000 material covering booklet/brochure will be printed topics on Anemia, to be distributed among the thalassemia, students during screening at Haemophilia & VBD school and during activities and 12.8.1 events conducted by the district.Target students is based on information given by UDISE for students of class 9th of Govt/Govt. aided school in all districts.
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12.8.1 Retro reflective board 12.8.1 Temporary Hoardings
13. Quality Assurance - NIL 14. Drug Warehousing and Logistics - NIL 15. PPP - NIL 16. Programme Management - NIL 17. IT Initiatives for Strengthening Service Delivery
New Old Budget Head Unit Quantity/target Amount Remarks FMR FMR Cost Approved Code Code (Rs)
17.4 B.14.15 e-Raktkosh – - - - Refer to strengthening of blood services guidelines.
Summary of Approvals 2020-21 : Tehri Total Approved FMR Code Budget Head (INR In Lakhs ) U.1 Service Delivery - Facility Based 0.64 U.2 Service Delivery - Community Based 1.30 U.9 Training & Capacity Building 0.59 U.11 IEC/BCC 1.8 U.12 Printing 0.5 Total 4.83
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Chapter 6 PC PNDT Program MISSION: The mission of PNDT program is to improve the sex ratio at birth by regulating the pre- conception and prenatal diagnostic techniques misused for sex selection.
Guiding Principle: Deterrence for unethical practice sex selection to ensure improvement in the child sex ratio
Implementation of PC&PNDT Act. STRATEGIES: Formation & Strenghten of PNDT Cell at state and district level Establishment of statutory bodies under the PC&PNDT Act > Constitution of State Supervisory Board > Reconstitution every three years (other than ex-officio members) > Two meetings in a year > Notification of three members Sate Appropriate Authority, > Constitution of 8 member State Advisory Committee - Reconstitution in every 3 years - 4 meetings in a year > Constitution of State Appellant Authority > Notification of District Appropriate Authorities > Constitution of 8 member district Advisory Committees - Reconstitution in every 3 years
Strengthening of monitoring mechanisms > Monitoring of sex ratio at birth through civil registration of birth data > Formulation of Inspection and Monitoring committees > Increasing the monitoring visits > Review and evaluation of registration records > On line filling and medical audit of form Fs > Ensure compliance for maintenance of records mandatory under the Act > Ensure regular quarterly progress reports at state and district level Capacity building and sensitisation of program managers and other officers. > Appropriate Authorities > Advisory committee members > Nodal officers both State and District
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Last 4 Year Sex ratio at birth as per HMIS DATA
Sex Ratio at Birth(Source- HMIS) District 2016-17 2017-18 2018-19 2019-20
Almora 947 930 977 981
Bageshwar 925 895 956 1004
Chamoli 893 904 895 879
Champawat 973 922 895 971
Dehradun 923 935 931 968
Garhwal 884 901 913 949
Hardwar 917 918 937 953
Nainital 898 900 940 901
Pithoragarh 873 866 904 881
Rudraprayag 891 904 926 920
Tehri Garhwal 957 913 925 950
Udham Singh Nagar 908 942 961 956
Uttarkashi 971 926 925 985
Uttarakhand 914 919 938 948
Regarding Preparation of District ROP , District has been categorized into 3 group i.e
District having more than 40 ultrasound machines
District having 15-40 ultrasound machine
District Having less than 15 ultrasound machines
And funds are allocated accordingly for Mobility support , district workshop & support to PNDT cell
U.1 Service Delivery - Facility Based -NIL
U.2 Service Delivery - Community Based -NIL
U.3 Community Interventions -NIL
U.4 Untied Fund -NIL
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U.5 Infrastructure -NIL
U.6 Procurement -NIL
U.7 Referral Transport -NIL
U.8 Service Delivery - Human Resources -NIL
U.9 Training & Capacity building
Unit Budget New Old Quantity/ Budget Head Cost (Rs. Remark FMR FMR Target (Rs) Lakhs) Training of Medical Officers conducting Pre- 9.5.21.2 50000 1 0.50 natal diagnostic procedure in Public Health Facilities
U.10 Review, Research, Surveillance & Surveys --NIL
U.11 IEC/BCC -NIL
U.12 Printing -NIL
U.13 Quality Assurance -NIL
U.14 Drug Warehousing and Logistics -NIL
U.15 PPP -NIL
U.16 Programme Management
Unit Budget New Quantity/ Old FMR Budget Head Cost (Rs. Remark FMR Target (Rs) Lakhs) Programme Management 16 1.05 Sub Annexure PNDT 16.2 activities As per PC&PNDT Act district Inspection monitoring committee has to inspect each Ultrasound center within 90 days. Nhm is providing Mobility support to conduct these Inspections; In addition it can also be used in mobility for implemention of PC&PNDT act. Approved Rs 0.35 Lakhs for mobility support regarding Mobility 16.2.2 A.7.3 35000 1 0.35 regular inspection & support Monitoring of ultrasound centers as per ACT.
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Other PNDT 16.2.2 A.7.2 activities
District to conduct a sensitization Workshop in district to sensitized various stakeholders in district or general public on spread awareness of PC&PNDT Act.
Approved Rs. 0.35 District Level 16. 2.3 lakhs for District Workshop 35000 1 0. 35 level workshop
Separate contigency fund allocated on Category basis for Implementation of PC&PNDT Act. it can be used in persual of court cases , documentation , office support etc.
Approved Rs. 0.35 lakhs for Contigency 16. 2.3 Contingency fund to Fund implement PCPNDT 35000 1 0.35 Act. District coordinator District salary part will be 16.4.2.1.4 A.10.2.8.1.a Coordinators share by HR Section. U.17 IT Initiative for Strengthening service delivery -NIL
U.18 Innovations -NIL
Summary of Approvals-PNDT-Tehri
FMR Budget Head Total Amount Approved U.9 Training & Capacity building 0.50 U.11 IEC/BCC In IEC Section U.12 Printing 0 U.16 Programme Management 1.05 Total 1.55
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Chapter-7 Human Resources for Programme Management, Nursing & District/Block PMU Mobility
Total Summary of Approvals: HR for PM, Ayush Wing & PMU Mobility
Total Amount Approved FMR Budget Head (In Lakh) U.8 Service Delivery – Human Resource 573.02
U.16 Programme Management ( HR ) 191.35
16.1.3.3.3 DPMU mobility 4.8 Rs 2.40 lakhs per block 16.1.3.4.3 21.6
Total 790.77
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Chapter -8 Immunization
Universal Immunization Programme (UIP) is one of the largest programs in the world on the basis of quantities of vaccine used, number of beneficiaries, number of immunization session organized, geographical spread and diversity of areas covered. Immunization programme targets to caters to 26 million infants and 30 million pregnant women, saving 2.5 million lives each year. The Program has contributed significantly to saving the lives of millions of children and ensuring that they thrive.
Today, all countries have national immunization Programs, and in most developing counties, children under five years of age are immunized with the standard WHO recommended vaccines that protect against- tuberculosis, diphtheria, tetanus (including nenonatal tetanus through immunization of mothers), pertussis, polio, measles, hepatitis B, and Haemophilus influenza type b (Hib). These vaccines prevent more than 2.5 million child deaths each year.
In Immunization Programme public health milestone have been achieved recently with India completing five years of being Polio free, WHO certification of the India having eliminated Maternal and Neonatal Tetanus and the tOPV to bOPV switch. This special countrywide initiative has been successful mainly due the unstinted support and active involvement of the state governments, health staff at all levels, partner agencies and other stakeholders.
The last five years has seen a dramatic change in the landscape of routine immunization with new vaccines being introduced, open vial policy implemented, strengthening of AEFI system, eVIN, Mission Indradhansuh etc. Implementation has been strengthened with capacity building of personnel as well as improvements in service delivery.
The broad strategy includes four basic elements:-
Ensure revision of micro plans in all blocks and urban areas in each district to ensure availability of sufficient vaccinators and all vaccines during routine immunization sessions. Develop special plans to reach the unreached children in high risk pockets such as urban slums, construction sites, brick kilns, nomadic sites and hard to reach areas. Increase awareness and demand for immunization services by intensive communication efforts to deliver improved community participation. Intensive training of the frontline workers to build the capacity of these workers for quality immunization services. Ensure engagement and accountability of district administrative and health machinery for implementation of this operation by strengthening district task force meetings. To strengthen RI services and coverage district to ensure that all the approval activities are done in time.
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Immunization Budget Sheet for FY 2019-20 FMR Code Budget Unit Targe Amou Remarks Head Cost t nt (in Rs Appro ) ved (Rs. in lakh) 1. Service Delivery (Facility Based) Under this activity funds is earmarked for petty consumable items for district Under Routine Immunizatio n Consumabl es for 1.3.2.4 computer 12000 1 0.12 Rs. 12000/- per year per district including provision for internet access for strengthenin g RI 2. Service Delivery (Community Based) Under this activity funds allocated for providing operational cost for Pulse Polio Immunization Programme and in urban area where ANM is not available or appointed, an alternate vaccinator can be hired for the these session sites NID/SNID round are organised as per Pulse Polio directions from GOI for the same 2.2.8 operating 4 0.00 separate budget sheet will be to all costs Districts at the time of activity after receiving Microloans. Focus on Rs. 450 per session for 4 session per slum & month per slum & Rs. 300 per month as underserve contingency i.e a total of Rs. 2100 per d areas in month per slum urban areas/altern 2.3.1. ative C.1.f 2100 3 0.76 9 vaccinator for slums (only where regular ANM under NUHM not engaged) Mobility Budget approved @ Rs. 450 per support for session for vaccinators for coverage in mobile vacant 50 SCs. health team/ 2.3.1. TA/DA to 450 350 1.58 10 vaccinators for coverage in vacant sub- centres
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3. Community Intervention Under this activity ASHA will receive performance –based incentive for full and complete immunization and for mobilization of pregnant Women and targeted children for immunization Rs 100 per child for full immunization in 3.1.1.1.11 100 8819 8.82 1st year of age ( about 90% of total target)
ASHA Rs 75 per child for ensuring complete 3.1.1.1.11 Incentive 75 7349 5.51 immunization upto 2nd year of age. ( 75 under % of total target) Immunizatio n Mobilization of children Total 14688 sessions (204S.C @6 through 1468 Sessions/month for 12 months 3.1.3.4 150 22.03 ASHA or 8 including one outreach sessions per other month mobilizers 4. Untied Fund Nil 5. Infrastructure Strengthening Nil 6. Procurement Fund allocated for procurement of red and black plastic bags for containment of medical waste after post RI session and for cutting the AD syringe at the hub immediately after administering the injection at the session site and bleach and Twin bucket required for disinfecting medical/bio waste. Hub Cutter GoI has merged it with FMR Code: 6.1.1.10.a 0 0 0 6.2.8.2 Segregation and safe disposal methods for immunizatio n waste: Red bags - use for A total of Rs 6/ - required for a set of plastic part 1468 6.2.8.1 6 0.88 Red and Black bag for each session for of syringe, 8 14688 sessions. Empty unbroken vials. Black bags- use for Needle Cap/Wrapp ers. Disinfect with 1% bleaching Budget approved as per revised norm. powder Bleach/Hypochlorite solution/ Hub 6.2.8.2 1500 38 0.57 solution cutter & Twin bucket @ Rs 1500 per To prepare PHC/CHC per year for Twin bucket 1% Hypochlorit
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e solution, dissolve 10- 15g or 1 tablespoonf ul of bleaching powder in 1 liter of water, in a well ventilated area. Use plastic containers as metal containers are corroded rapidly and also affect the bleach. For this Rs. 1000 per PHC/CHC per year, Twin bucket 8. Human Resources - Service Delivery Under this head fund allocated for payment of salaries to service delivery staff Computer 16.8.2.1.9 Assistant - - - under RI Field HR will be shared by HR Division 16.8.2.16 Supervisor - - - SPMU separately under RI Refrigerator 8.1.16.2 Mechanic - - - under RI 9. Training and Capacity Building Under this regular capacity building of health functionaries at the village and SC level is essential to ensure sustained utilization of quality immunization services by the community. HWs or Vaccinators, HSs, ASHA, AWWs, Vaccine and Cold-Chain handlers and Data handlers to be regularly trained in immunization at block/CHCs/PHCs level. District level Orientation training including Hep B, Measles & 30 participants per batch for 09 batches JE(whereve 9.5.10.1 1200 260 3.12 of ANMs,HVs, SN etc @ r required) 1200/participant as per RCH norms. for 2 days ANM, Multi Purpose Health Worker (Male),
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LHV, Health Assistant (Male/Fema le)
Three day training including Hep B, MR & JE(whereve Training will be facilitated by DHFWTC, 9.5.10.2 r required) - - 0.42 Chander Nagar, Dehradun of Medical Officers of RI using revised MO training module) Two day cold chain handlers training for Refresher training at district level for 25 block level participants per batch for 03 batches of 9.5.10.2 cold chain 1200 70 0.84 CCH @1200/ participant as per RCH handlers by norms State and district cold chain officers One day training of block level Refresher training at district level for 09 data 9.5.10.2 600 10 0.06 block Data Handler, 01 District Hospital, handlers by @600/ participant as per RCH norms DIOs and District cold chain officer 10. Review, Research & Surveys and Surveillance Nil 11. IEC/BCC. IEC activity 11.8. for IEC/BCC activity will be in IEC district 1 immunizatio RoP 2020-21. n 12. Printing Under this head fund approved for the printing of MCP card, tally sheet and other formats Printing of Amount approved only for the printing MCP cards, of new version of 2018 MCP Cards, safe tally sheets, monitoring forms, etc 1053 12.10.1 motherhood 20 2.11 @Rs20/beneficiary, under 1 booklets, immunization program only. tally sheets, monitoring
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forms etc.
Printing & disseminati on of Immunizatio Budget Approved Rs. 0.35 lacs for 12.10.2 n Cards, 1000 35 0.35 printing of 5 job aids (5 x Rs.200) for 35 Tally CCP @ Rs. 1000 per CCP Sheets, Monitoring forms etc. 13. Quality Assurance 0.00 Nil 14. Drug Warehouse and Logistics Under this activity fund allocated for cold chain maintenance and logistic supply. Cold chain is a system of storing and transporting vaccines at recommended temperature from the point of manufacture to the point of use. Alternative 9792 session per year budgeted @ Rs. vaccine 200 per session, This is be based upon delivery in the previous year’s expenditure. The hard to Budget to be used in deferential reach areas category defined at your end which can be Zero for AVD to a maximum of 14.2.4 200 9792 19.58 upper capping .In cases where more than Rs 200 is given for AVD then a permission to be taken from Chairman DHS and such areas to be notified ( upper capping for such areas would be Rs 450) POL for Pool amount for vaccine collection and vaccine distribution (Rs 50000 per RVS and 3 Rs. delivery districts (Haridwar,Tehri and 20000 from State Uttarakashi) for collecting vaccine from 14.2.6 0 per 1 2.00 to district SVS , & Rs 150000 at state level. district and from District wise allocation based on No. of s district to Cold Chain Points.) PHC/CHCs Cold chain Rs 1000/- per unit for 36 cold chain 14.2.7 maintenanc 36 0.55 points , Rs 20000/district e 15. PPP Nil 16. Programme Management Activities Under this activity fund approved for delivery of RI services to a community by proper micro planning, regular review meeting and supervision and monitoring through collection and analysis of data on various aspects of programme activities To develop 16.1.1.6 micro plan 100 204 0.20 153 SC*Rs100 per SC at sub- centre level For consolidatio @ Rs. 1000 / block ( 09 blocks) & Rs. 16.1.1.7 9 0.11 n of micro 2000 / district plans at
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block level
Quarterly Average 20 participants @3653 per review meeting (i.e., Rs.150*9 Blocks* 5 meetings Person*4 meetings) exclusive for RI at 16.1.2.1.14 district level 4 0.27 with Block MOs, CDPO, and other stake holders Quarterly Honorarium for travel of 1031 ASHAs review @ Rs. 75 per quarter for each ASHA meetings and @ Rs. 20000 for disposal of MO- 16.1.2.1.15 exclusive 90 4 3.97 IC for meeting expenses (refreshment, for RI at stationary and misc. block level expenses)ASHA/ANM/AWW etc. in each Quarter Mobility For District level Officers 1 lacs for Support for Districts @ 13,684 per block for District supervision level supervision and 225280/- for all 16.1.3.3.7 4.10 for district Blocks for supervision @ of 1406 per level SC officers. 17. IT Initiatives - Service 0.00 Nil Delivery 18. Innovations 0.00 Nil
Summary of Approvals ROP 19-20 : Immunization FMR Budget Head Total Amount Code Approved U.1 Service Delivery (Facility Based) 0.12 U.2 Service Delivery (Community Based) 2.33 U.3 Community Intervention 36.36 U.6 Procurement 1.45 U.9 Training and Capacity Building 4.44 U.12 Printing 2.46 U.14 Drug Warehouse and Logistics 22.13 U.16 Programme Management Activities 8.66 77.95 Total
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Chapter -9 ASHA and Community Process
ASHA Programme was launched in 2005-06 at grass root level under the umbrella of National Health Mission. NHM envisages achievement of universal access to equitable, affordable & quality health care services that are accountable and responsive to people's needs. One of the key components of the National Health Mission is to provide every village and urban areas in the country with a trained female community health activist ASHA (Accredited Social Health Activist), selected from the village and urban area itself and accountable to it, the ASHAs are trained to work as an interface between the community and the public health system.
U.3 Community Intervention
Home Based Newborn Care (HBNC) A major proportion of infant mortality occurs in neonates. As an effective intervention for reducing IMR. ASHA worker provides Home Based Newborn Care. ASHA visits to all newborns after delivery. ASHA conduct 6 Visits for Institutional deliveries and 7 visits for home delivery. After the complete visits the ASHA is eligible for the incentive of Rs. 250/- per case for complete HBNC. The approved budget is Rs. 14.50 lakhs (5800 Children* Rs. 250 = 14.50 lakhs)
Home based care for Young Children (HBYC) To fill the design gap in the present health and nutrition programmes for children, the Government of India is now implementing Home based care for Young Children (HBYC) through a series of structured home visits schedule by ASHAs to all children attaining the age of 3 months onwards with an objective to ensure counseling for complementary feeding, growth monitoring, vaccination, WASH practices and sickness related counseling. As an effective intervention for reducing child mortality, ASHA worker will provide Home based care for Young Children (HBYC).
ASHA worker will provide HBYC by conducting 5 visits per child @ Rs. 50/- per visit. In case of more than one child like twins/triplets the amount of incentive will be provided per child. The payment will be given after validating that age appropriate vaccination is completed and recorded along with the weight in MCP card.
The ASHA Facilitators will receive Rs. 500/- per month. She will monitor the coverage of young children by ASHAs, validate activities and records updated during household visits and handhold ASHAs in performing HBYC related tasks through on the job mentoring and support. It is also desirable that at least 10% home visits are duly verified by the ANM/ASHA Facilitator after checking the required documentation.
The approved budget for Home based care for Young Children incentive is Rs. 11.61 lakhs (Rs. 10.56 lakhs for ASHAs and Rs. 1.05 lakhs for AF).
ASHA Help Desk: The ASHA help desk is the first designated site in the hospitals where patients can get all the information about the health facilities availed by ASHA worker. ASHA receives incentive of Rs. 150/- per day. ASHA Help Desk approved budget is Rs. 1.10 lakh @ Rs. 300/- for each help desk for 365 days (Rs 150/- per ASHA).
Induction Training: All new selected ASHAs will undergo an eight days induction training to orient her to her role and responsibilities, provide the skills of community rapport building and leadership, and an understanding of the health system and rights based approach to health. The
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Approved Budget is Rs.1.35 lakh for 8 days induction training @ Rs. 5391/- per ASHA for 25 new ASHAs (This also includes printing of training material).
Module VI & VII Training: All new ASHAs are required to be qualified in a set of competencies related to basic reproductive, maternal, newborn, child health, nutrition and infectious diseases such as malaria and tuberculosis. The existing Modules 6 and 7 will be used for this training. The approved budget is Rs 0.88 lakh for 5 days module 6 &7 round 1 training of ASHA @ Rs. 3514/- per ASHA for Training for 25 new approved ASHAs & Rs 1.40 lakh approved for 5 days module 6 &7 round 2 training of ASHA @ Rs. 3511/- per ASHA for Training for 40 ASHAs (25 Approved ASHAs of FY 2018-19 & 15 replaced ASHAs of FY 2019-20). This also includes printing of training material.
Supplementary Training for ASHAs: The changing global climate is leading to a greater incidence of extreme weather events and natural disasters. The natural and man-made disasters have a great impact on physical and mental health and health system. Disaster preparedness is therefore important at all levels of the health system. Being the first contact of the health system to the community, ASHA workers have a great role in managing the disasters at the village level. This disaster management training attempt to assess the awareness regarding disaster management among ASHAs & ASHA Facilitators in the community. This training can also serve to reinforce existing skills in areas where the ASHAs need further inputs. The new skills would be specific for disaster management. The approved budget is Rs. 29.73 lakhs for 3 days Disaster Management training of 1056 ASHA & 35 AF @ Rs. 2725/- per ASHA & AF (This also includes printing of training material).
Training of ASHA facilitator: Training of ASHA facilitators can also serve to emphasize existing skills in areas where the ASHA Facilitators need further inputs. The approved budget is Rs. 0.93 lakhs for two days orientation of supportive supervision for 35 AF @ Rs. 2657/- per AF
Training under HBYC: A defined set of skills will be required by ASHA, AF and ANM to conduct effective home visits and fulfill the specified objectives. Many of the skills to deliver relevant information and services through home visit is taught to ASHAs in Modules 6 & 7. In order to reinforce existing skills and provide new set of skills, an additional round of 5 days training shall be conducted with adequate hands on practice. The approved budget is Rs 60.03 Lakh for 5 days HBYC training of 1056 ASHA, 35 ASHA facilitators and 223 ANM @ Rs. 4569/- per participants for 5 days.
Supervision costs by ASHA facilitators:
ASHA Facilitator should assist Block Community Mobilizer and provide continuous hand holding support to ASHAs. She supports ASHA in coordination with ANM, AWW, PRI, VHSNC etc. It is expected that she will spend 20 days in the field to provide support to ASHAs in her area of operation. The supervision/ Mobility cost for 20 visits is Rs. 6000/- @ Rs. 300/- per visit and an incentive to ASHA Facilitator is paid for conduct 10 PLA meeting in a month @ Rs. 100/- per meeting. The approved budget is Rs. 29.40 lakh for 35 AF (Rs 25.20 lakhs for Mobility of 35 AF @ Rs. 6000/- per month for per AF, she will conduct 20 visits per month @ Rs. 300/- + Rs. 4.20 lakh for PLA meeting @ Rs. 1000/-, she will conduct 10 PLA meeting per month
Support Provision to ASHA (Uniform): The approved budget is Rs. 5.58 lakh for ASHA Uniform @ Rs 500/- (1056 ASHAs + 25 new ASHA +35 AF).).
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Awards to ASHAs link workers: ASHA Sammelan is an activity in which award is instituted to acknowledge the integral role of ASHA workers, ASHA Facilitators and one best Block Coordinator who have endlessly contributed at the grassroot level. Awards are given in three categories comprising of First prize Rs. 5000, second prize Rs. 3000 and third prize Rs. 1000. The approved budget is Rs. 3.38 lakh for 1056 existing ASHA + 25 new ASHA + 35 AF + 9 Block Coordinator + 01 DCM & 01 DEO. ASHA Sammelan & Awards includes all the arrangement and refreshment related to ASHA Sammelan.
ASHA Mentoring by ASHA Facilitators for implementing VHSNC VISHWAS & PLA & other: This activity is approved for ASHA mentoring by AFs for VHSNC, VISHWAS & PLA. Every AF is supposed to mentor at least 2 VHSNC per month for above activity for which an incentive of Rs. 100/- is proposed for each ASHA mentoring i.e. maximum of Rs 200/- per month per AF. The activity is proposed for 12 months as the AFs will be sensitized by district trainers. The approved budget is Rs. 0.84 Lakh for 35 ASHA Facilitator for 12 month @ Rs. 200 per AF per month (1 AF will orient 2 VHSNC per month @ Rs. 100/- per VHSNC regarding implementing VHSNC VISHWAS & PLA & other
Community Action for Health (CAH): CAH is an important pillar of NHM’s accountability framework in order to ensure that the services reach those for whom they are intended. Under CAH, community enquiry and facility assessment are done by using structured tool. Jansamwad is organized at district and each block for advocacy with key stake holders.
District level Jansamwad: Budget approved for organizing District Level Jan Samwaad. The Platform will be used to present a consolidated block level report cards and action taken report from block level Jan Samwaad. The platform will also be used to present the findings from Uttarakhand Social Audit Accountability and Transparency Agency (USAATA) along with the community monitoring data sets from blocks. The approved budget includes making necessary copies of community monitoring toolkit at the district level for its circulation among Block Coordinators. The approved budget is Rs. 0.40 lakh per district
Block level Jansamwad The approved budget is Rs. 1.80 lakh for organizing Block level Jan Samwaad to facilitate discussion between the service providers and the community. The platform will use community monitoring data sets and report card to facilitate this Jan Samwaad @ Rs. 20,000/- per Jan Samwaad.
New Amoun Old FMR Unit Physical FMR Budget Head t in Remark code Cost / Target Code Lakh 210.14 Community U.3 175.67 Intervention The approved budget is Rs.14.50 Lakhs for HBNC visits @ Incentive for Rs. 250/- per case B1.1.3.2. Home Based 3.1.1.1.3 250 5800 14.50 after completion of 1 Newborn Care 6th visit for programme Institutional delivery & 7th visit for home delivery
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The approved budget Incentive to is Rs.10.56 Lakhs for 3.1.1.1.1 ASHA for quartely visit of 250 4224 10.56 2 quarterly visit HBYC @ Rs. 250/- under HBYC per complete HBYC Visit Incentive to The approved budget ASHA is Rs. 1.05 Lakhs for 3.1.1.1.1 Facilitators for 500 35 1.05 monthly visit of 2 quarterly visit HBYC @ Rs. 500/- under HBYC per month The approved budget is Rs. 1.10 Lakh for Any other ASHA Help Desk @ ASHA 3.1.1.6.3 B.1.3.1.2 300 1 1.10 Rs. 300/- (01 Help incentives Desk*2 ASHAs*Rs (please specify) 150/- per ASHA per day* 365 days) The approved budget is Rs.1.35 Lakh for 8 days induction training @ Rs. Induction 3.1.2.1 B1.1.1.1 5391 25 1.35 5,391/- per ASHA Training for 25 new approved ASHAs (This also includes printing of training material) The approved budget is Rs 0.88 Lakh for 5 days training on module 6 &7 round 1 Module VI & VII @ Rs.3,514 per 3.1.2.2 B1.1.1.2 3514 25 0.88 Round I ASHA for 25 new approved ASHAs (This also includes printing of training material) The approved budget is Rs 1.40 Lakh for 5 days training on module 6 &7 round 2 @ Rs.3,511 per ASHA for 40 ASHAs Module VI & VII 3.1.2.2 B1.1.1.2 3511 40 1.40 (25 Approved ASHAs Round II of FY 2018-19 & 15 replaced ASHAs of FY 2019-20) (This also includes printing of training material) The approved budget Supplementary is Rs. 29.73 Lakhs Training for for 3 days training @ 3.1.2.3 ASHAs 2725 1091 29.73 Rs. 2,725/- per (Disaster person for 1437 training) ASHAS & 72 AF.
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(This also includes printing of training material) The approved budget Training of is Rs. 0.93 Lakhs for ASHA two days orientation B1.1.1.5. 3.1.2.7 Facilitator 2657 35 0.93 on supportive 5 (VISHWAS & supervision @ Rs. VHSNC) 2,657/- per AF for 35 ASHA Facilitator The approved budget is Rs. 60.03 Lakh for 5 days HBYC Training under training @ Rs. 3.1.2.8 4569 1314 60.03 HBYC 1,37,160/- per batch for 1437 ASHA + 72 ASHA facilitators + 164 ANM The approved budget is Rs.29.40 Lakh for 35 AF @ Rs. 7000/- per AF (Rs 25.20 for Mobility of AF @ Rs. Supervision 6000/- per month for B1.1.1.4. costs by ASHA per AF, she will 3.1.3.1 7000 35 29.40 1 facilitators(12 conduct 20 visits per months) month @ Rs. 300/- + Rs. 4.20 Lakh for PLA meeting @ Rs. 1000/-, she will conduct 10 PLA meeting per month) The approved budget Support is Rs.5.58 Lakh for Provision to ASHA Uniform @ Rs 3.1.3.2 500 1116 5.58 ASHA 500/- (1056 ASHAs (Uniform) + 25 new ASHA +35 AF). The approved budget is Rs. 3.38 Lakh for ASHA Sammelan & awards including Refreshment & all Awards to arrangements with 3.1.3.3 B1.1.4 ASHAs link 300 1127 3.38 awards for workers Sammalen @ 300/- for 1056 existing ASHA + 25 new ASHA + 35 AF + 9 Block Coordinator + 01 DCM & 01 DEO
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The approved budget is Rs. 0.84 Lakh for 35 ASHA Facilitator ASHA for 12 month @ Rs. Mentoring by 200/- per AF per ASHA month (1 AF will Facilitators for 3.1.3.5 200 35 0.84 orient 2 VHSNC per implementing month @ Rs. 100/- VHSNC per VHSNC VISHWAS & regarding PLA & other implementing VHSNC VISHWAS & PLA & other Community Action for 3.2.4 B15.1 Health The approved budget is Rs 0.40 Lakhs for 4000 District level 3.2.4.2 District level 1 0.40 0 Jansamwad @ Rs. 40,000/- per Jansamwad The approved budget is Rs 1.80 Lakhs for 2000 3.2.4.3 B15.1.3 Block Level 9 1.80 block level 0 Jansamwad @ Rs. 20,000/- per block The approved budget is Rs. 12.67 Lakhs Any other for PLA meeting for B1.1.3.6. (please specify) 3.2.4.5 1200 1056 12.67 1056 existing 4 PLA Meeting - ASHAs for 12 Existing ASHA months @ Rs. 100/- per month. The approved budget is Rs. 0.08 lakhs for Any other PLA meeting for 25 B1.1.3.6. (please specify) 3.2.4.5 300 25 0.08 New approved 4 PLA Meeting - ASHAs for 3 months New ASHA @ Rs. 100/- per month.
U.6 Procurement
Home Based Newborn Care (HBNC) is a care of new born baby and mother by ASHA through regular home visits. Six home visits in the case of institutional delivery and seven visits in the case of home delivery. HBNC is a focused effort at implementing evidence based cost effective intervention that affect neonatal health outcome. HBNC visit comprises the continuum care of newborn survival. ASHA have a HBNC kit during the HBNC visit which is replenished every year.
The approved budget is Rs 0.40 Lakhs approved for 25 New ASHA & 15 replaced ASHAs of FY 2019-20 @ Rs. 1,000/- per New HBNC kit.
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Replenishment of ASHA HBNC kits: ASHA carry a HBNC kit during the HBNC visit which is replenished every year. The approved budget is Rs. 2.11 Lakhs approved for replenishment of ASHA HBNC Kit @ RS. 200/- per Kit for 1056 existing ASHA.
New Old Budget Unit Quantity/ Amount FMR FMR Remark Head Cost Target in Lakh Code code Procureme U.6 2.51 nt The approved budget is Rs 0.40 Lakhs for 25 New 6.2.6.3 New ASHA 1000 40 0.40 ASHA & 15 replaced ASHAs HBNC Kits of FY 2019-20 @ Rs. 1,000/- per New HBNC kit. The approved budget is B.16.2. Replenishme Rs.2.11 Lakhs for 6.2.6.4 10.3.1. nt of ASHA 200 1056 2.11 replenishment of ASHA 2 HBNC kits HBNC Kit @ RS. 200/- per Kit for 1056 existing ASHA
U.12 Printing
The approved budget is Rs. 9.00 Lakh for printing of HBYC IEC materials and printing (Posters, Banners, Stickers, AV, HBYC cards & registers @ Rs. 100,000/- per block.
U.12 Printing 9.00 The approved budget is Rs. 9.00 Lakhs for prinitng of Printing cost HBYC training resource 12.2.12 100000 9 9.00 for HBYC material and related IEC like banner, Flex format etc @ Rs. 1,00,000/- per Block
U.16 Programme Management:
Review/orientation meetings for child health programmes: The approved budget is Rs. 1.00 lakhs for periodic assessment of HBYC program including baseline assessment in the District.
Mobility Cost for ASHA resource centre/ASHA mentoring group: Monitoring and Supervision of ASHAs is a key important pillar for successful implementation and functioning of ASHA programme. For which the fixed monitoring and supervisory visit of DCM & BC is mandatory. The approved budget is Rs. 4.07 Lakh for supervisory visit of DCM & BC. [Approved Rs. 0.18 lakhs for 1 DCM for 12 month @ Rs. 500/- per visit (DCM - 1x9x4x500/100000 = 0.18) & Rs. 3.89 lakhs for 9 BC for 12 months @ Rs. 300/- per visit (Block Coordinator - 9x12x12x300/100000 = 3.89)]
New Old Unit Quantity/ Amount FMR FMR Budget Head Remark Cost Target in Lakh Code code Programme U.16 5.91 Management
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The approved budget is Rs. 1.00 Lakhs for Review/orientatio periodic assessment 16.1.2. n meetings for 10000 1 1.00 of HBYC program 1.3 child health 0 including baseline programmes assessment in the District.
The approved budget Mobility Costs for is Rs. 0.18 lakhs 1 ASHA Resource DCM for 12 month @ 16.1.3. B1.1.5 Centre/ASHA 500 1 0.18 Rs. 500/- per visit. 3.5 .4 Mentoring Group (Kindly Specify) - DCM - DCM 1x9x4x500/100000 = 0.18
The approved budget is Rs. 3.89 lakhs for Mobility Costs for ASHA Resource 9 Block Coordinator 16.1.3. B1.1.5 Centre/ASHA for 12 months @ Rs. 300 9 3.89 3.5 .4 Mentoring Group 300/- per visit. (Kindly Specify) - Block Coordinator - Block Coordinator 9x12x12x300/100000 = 3.89
Monthly Review Meeting of ASHA The approved budget Facilitator with is Rs. 0.84 lakhs for 16.1.3. B1.1.5 BCM at Block 2400 35 0.84 35 AF for 12 months 4.4 .5 level-cost of travel and @ Rs. 200/- per meeting meeting. expenses
U.17 Initiatives for Strengthening Service Delivery:
New Old Unit Quantity/ Amount FMR FMR Budget Head Remark Cost Target in Lakh Code code Initiatives for U 17 Strengthening 13.22 Service Delivery The approved budget is Other IT Rs. 13.22 Lakh for CUG Initiatives for Sim for 1056 ASHA + 35 17.7 1200 1102 13.22 service delivery AF + 9 BCM + 1 DEO + 1 (Please Specify) DCM @ Rs. 100/- per person per month.
U.18 Innovation:
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Social Security Scheme: Pradhan Mantri Suraksha Bima Yojna (PMSBY) and Pradhan Mantri Jeevan Jyoti Bima Yojna (PMJJBY)
New Old Budget Unit Quantity/ Amount FMR FMR Remark Head Cost Target in Lakh Code code U.18 Innovation 3.82 The approved budget is Rs. 3.82 Lakh for Social Security for 1056 existing ASHAs + 25 New Approved ASHAs + 35 Social AF @ Rs. 342/- (Pradhan B14.17 Security 342 1116 3.82 Mantri Jeevan Jyoti Bima Benefits Yojna @ Rs.330/- per annum and Pradhan Mantri Suraksha Bima Yojna @ Rs. 12/- per annum)
Summary of Approvals in FY 2020-21 Total Approved (INR FMR Code Budget Head In Lakhs ) 175.67 U.3 Community Interventions 2.51 U.6 Procurement 9.00 U.12 Printing 5.91 U.16 Programme Management 13.22 U.17 IT Initiatives for strengthening Service Delivery 3.82 U.18 Innovations (if any) Total 210.14
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Chapter -10 Untied Fund for Public Health Facilities
Rogi Kalyan Samiti launched in the early nineties to improve hospital upkeep and maintenance and enable a source of flexible funding, were scaled up country wide through the National Health Mission. In addition the infusion of untied and flexible funds at each facility provided every Rogi Kalyan Samiti with funding to meet local needs and ensure that the hospital was not only able to respond to the increased utilization of services but also to expand the package of services through sourcing in additional services or purchasing necessary equipments and other items to render quality public health services for citizens.
A key function of Rogi Kalyan Samiti is to oversee the process of quality improvement which spans the need of infrastructure, human resources and process related parameters. Addressing issues of cleanliness, upkeep and hygiene while being important and somewhat neglected are issues such as use of standard treatment protocols, effective grievance redressal, patient feedback and monitoring.
The quantum of funding for facilities under the National Health Mission has recently been revised and guidelines for untied grants now provide for funding based on facility caseloads and range of services offered. District Health Societies are empowered to allocate untied fund to various health facilities according to the performance and workload of health facilities in past financial year.
Suggested areas where untied funds may be used as follows:
1) Cleaning up of the facility especially in the labour room and post-partum space, cleaning and maintenance of the campus to ensure a pleasing appearance. 2) Outsourcing/contracting in of clinical/non-clinical services. 3) Transport of emergencies to referral centers/ Referral Transport. 4) Transport of laboratory samples during epidemic. 5) Provision of safe drinking water to patients. 6) Minor Repairs of building and furniture. 7) Building/Repairing Septic Tanks/Toilets. 8) Improved signage in the facility. 9) Arrangement of stay for poor patients and their attendants. 10) Setting up of Rogi Sahayata Kendra/Help Desk. 11) Providing for Medicines and diagnostics for needy people. 12) Arrangement for hygienic environment for washrooms and toilets. 13) Making arrangements for proper disposal of wastage etc. 14) Repair/Maintenance of Government owned vehicles. 15) Purchase of medical equipments. 16) Providing security at hospital premises for safety/security of patients through outsourcing.
District must ensure that Action Plan for utilization of untied fund for each health facility is duly approved from the Chairperson of concerned Rogi Kalyan Samiti and a copy of approved plan of each health facility is shared with State.
Untied Fund for public health facilities including VHSNC
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Untied Fund for public health facilities including VHSNC New Old Budget Unit Target Approved Remarks FMR FMR Head cost Amount
4.1.1 B.2.1 District Rs. 1 DH 5 Approved for 1 DH @ Rs. 5 Hospitals 500000 lakh
4.1.2 B.2.2 SDH Rs. 1 SDH 2.5 Approved for 1 SDH @ Rs. 250000 2.5 lakh per SDH
4.1.3 B.2.3 CHCs Rs. 5 12.5 Approved for 5 CHCs @ Rs.2. 250000 CHCs 5 lakh per CHC
4.1.4 B.2.4 PHCs Rs. 27 23.625 Approved for 26 PHCs @ 87500 PHCs Rs0.875 lakh per PHC and Rs 1.75 Lakhs for Pilkhi
4.1.5 B.2.5 Sub Rs. - 25 Untied fund approved @ Rs. Centers 10000 10000 per Sub Center for 160 Sub Centers and AMG for 90 Sub Centers @ Rs. 10000 per Sub Center.
4.1.6 VHSNC 5000 1605 80.25 Total 148.875
Note – In view of Covid-19 pandemic condition, untied fund released to VHNSCs may be if required utilized for the sanitization of Quarantine facilities.
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Chapter 11 Health and wellness centres
The National Health Policy, 2017 recommended strengthening the delivery of Primary Health Care, through establishment of “Health and Wellness Centres” as the platform to deliver Comprehensive Primary Health Care and called for a commitment of two thirds of the health budget to primary health care.
In February 2018, the Government of India’s announced that 1,50,000 Health & Wellness Centres (HWCs) would be created by transforming existing Sub centres and Primary Health centres to deliver Comprehensive Primary Health care and declared this as one of the two components of Ayushman Bharat. This was the first step in the conversion of policy articulations to a budgetary commitment.
The delivery of CPHC through HWCs rests substantially on the institutional mechanisms, governance structures, and systems created under the National Health Mission (NHM). NHM, as part of health system reform in the country, in its nearly 12 years of implementation, has supported states to create several platforms for delivery of community based health systems, expanding Human Resources for Health and infrastructure towards strengthening primary and secondary care. Though largely limited to a few conditions, NHM created mechanisms for expanded coverage and reach, and developed systems for improved delivery of medicines, diagnostics and improved reporting. About five years ago, these components were also introduced in urban areas.
Thus, although the delivery of universal Comprehensive Primary Health Care, through HWCs builds on existing systems, it will need change management and systems design at various levels, to realise its full potential. The other component of Ayushman Bharat, namely the National Health Protection Mission (NHPM) aims to provide financial protection for secondary and tertiary care to about 40% of India’s households. Its success and affordability rests substantially on the effectiveness of provision of Comprehensive Primary Health Care through HWCs. Together, the two components of Ayushman Bharat will enable the realization of the aspiration for Universal Health Coverage.
A Primary Health Centre (PHC) that is linked to a cluster of HWCs would serve as the first point of referral for many disease conditions for the HWCs in its jurisdiction. In addition, it would also be strengthened as a HWC to deliver the expanded range of primary care services. The Medical Officer at the PHC would be responsible for ensuring that CPHC services are delivered through all HWCs in her/his area and through the PHC itself. The number and qualifications of staff at the PHC would continue as defined in the Indian Public Health Standards.
For PHCs to be strengthened to HWCs, support for training of PHC staff (Medical Officers, Staff Nurses, Pharmacist, and Lab Technicians), and provision of equipment for “Wellness Room”, the necessary IT infrastructure and the resources required for upgrading laboratory and diagnostic support to complement the expanded ranges of services would be provided. States could choose to modify staffing at HWC and PHC, based on local needs.
The HWC would deliver an expanded range of services. These services would be delivered at both Sub Health Centre (SHC) and in the PHCs, which are transformed as HWCs.
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The level of complexity of care of services delivered at the PHC would be higher than at the sub health centre level and this would be indicated in the care pathways and standard treatment guidelines that will be issued periodically.
New fmr Old fmr Budget head Physica Approved Remarks l target budget in lakhs
Rs. 40 lakhs Approved for 8 Renovation /up gradation of 5.1.1.1.5 5.1.1.1e HWCs - HSCs 40 SC in hilly/difficult terrain. 8 SC @ Rs. 5 Lakh Per SC.
Infrastructure 1. Approved Rs. 60 lakhs for Strengthening of 12 5.1.1.2.8 5.1.1.2h 60 Renovation /up gradation of 12 SC to Health & SC @ Rs. 5 Lakh Per SC. Wellness Centre
This is the first instalment, remaining budget will be given after Budget utilisation certificate received for given budget. This is a pooled budget so if costing of one centre is less and costing of other centre is more, the remaining money of one centre can be utilise for other centre according to the approved estimate. Approved Rs. 4.5 lakhs for organise yoga session at Any other operational health and (YOGA - wellness centre. 9.5.27.4 9.5.27.4 HONORARIUM) 15 4.5 Rs.250/session/HWC for 10 session in a month for 15 H&WCs – SHCs/PHCs (@ Rs. 30000/Centre for 12 months)
Note: District can also coordinate with local yoga teacher or involve yoga volunteers for free session.
Approved Rs.2.5 lakhs for IEC IECs for activity at 10 operational HWC- 11.24.1 11.24.1 10 2.5 HWCs SHC/PHC @ Rs. 250000/centre
Approved Rs 4.2 lakh for 21 Multi skilling of ASHA, 21 4.2 Centres (SHC) @ Rs. 9.5.27.2 ANM/MPW 20000/centre
Remarks: District NCD cell will ensure the activity done.
Summary of Approval: HWC/CPHC FMR Budget Head Total Approval (Rs. In Lakh) U.5 Infrastructure 100.0 U.9 Training & others 8.7 U.11 IEC 2.5 Total 111.2
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Chapter -12 Infrastructure & Civil work
New Old Budget Head Unit cost Quantity Amount Remark FMR FMR (Rs.) /Target Approved code code (Rs. in Lakh) 5.2.2.3 B5.1.1 CHCs 261.00 1 ------Work approved last lakh year, Rs. 50 lakh is Released in III rd instalment forconstruction of MO Transit Hostel (8 MO's transit room set with combined dining hall and kitchen) at CHC Chaund Lamb gaon (Tehri). Total approved project cost is Rs. 261.00 Rs Each. Work will be executed through State level. 5.1.2 B.4.3 Sub Centre 12000.00/ 94 11.28 Sub centre Rent and year rentapproved @ Rs. Contingencies 1000 per month for 12 months for 94 sub centre running in rented building in District-Tehri. Amount approved is Rs 11.28 lakh
Summary of Approvals 20-21 ; Infrastructure & Civil Work, TEHRI
FMR Code Budget Head Total Approved (INR In Lakhs )
U.5 11.28 Infrastructure Total 11.28
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Chapter -13 Information, Education & Communication/Behaviour Change Communication (IEC/BCC)
New Budget Head Unit Cost (In Quantity/ Amount Remarks FMR Rs.) Target approved Code (Rs. In lakh) 11.4 IEC/BCC activities under MH 11.4.2 Inter Personnal Communication District Dissemination @50000 1 0.50 The funds will be on Anemia Mukt allocated @0.50 per Bharat district to conduct the IPC activities for awareness about anemia at schools VHND sessions. 11.4.3 Any other IEC/BCC 1.00 lac 1 1.00 Rs. 1.00 lakh for activities (Please SUMAN programmes specify) as per SUMAN guidelines. 11.5.4 Media activities for awareness generation on National De-worming Day: miking/ inauguration event/ advertisement- Miking for awareness 3500 02 round 0.35 5 Miking activity (3 generation about rural and 2 NDD urban)@Rs.3500/-. Budget proposed for 2 rounds of NDD. National Deworming 5000 02 round 0.10 Budget approved for Day Inaugural 2 rounds of NDD. launches - District 11.6 IEC/BCC activities under FP 11.6.3 IEC & promotional @50000 1 0.50 This activity will be activities for World conducted at district Population Day level. celebration- Inauguration & other IEC activities i.e rallies, folk show, IEC materials etc 11.6.4 IEC & promotional @30000 1 0.30 This activity will be activities for conducted by district Vasectomy level. Fortnight celebration- IEC materials at district level
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11.8 IEC/BCC activities under Immunization Social Mobilization @3000/ 48 1.44 Social mobilization Meeting meeting meeting will be organized in underserved areas & slums, where acceptance for RI is very poor. In order to have better coverage, there is need to mobilize the religious leaders & resistant groups. 11.9 IEC/BCC activities under PNDT 11.9.1 Creating awareness on declining sex ratio issue (PNDT) Talk Shows in Degree 5000 4 0.20 Talk show will be Colleges /Universities conducted on the at District level National Girl child day 24 January, International womens day 08 March, International day of the girl child 11th Oct and one on any other day at District level at colleges/universities etc. 4Talk shows per District @ of average 5,000/- Nukkad Natak/Folk As per 27 (03 0.675 Nukkad Natak on Show approved shows/block social awareness rates by ) about PC-PNDT Act Cultural & its implications to department/DI declining sex PR, UK ratio.The activity will be conducted at village/block level, preferably during VHNDs & local Mela. IPC/Awareness @2000 9 blocks 0.18 Awareness campaign campaign through through ANM and ANM and ASHA’s ASHA’s @ 2000 per Block at District level. 11.11 IEC/BCC activities under NPPCD 11.11.1 IEC activities 20000 1 0.20 For IEC activities 11.14 IEC/BCC activities under NIDDCP 11.14.1 Health Education & 20000 1 0.20 Approved for Publicity for NIDDCP conducting IDD awareness activities
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including development of IEC materials and Global IDD Prevention Day. IEC/BCC activities 11.15 under NVBDCP 11.15.1 IEC/BCC for Malaria @25000 1 0.50 For IEC activities IEC/BCC for Social @20000 1 1.00 For IEC activities mobilization (Dengue 11.15.2 and Chikungunya) IEC/BCC Specific to 0 0 0 - 11.15.3 J.E. Endemic areas 11.16.1 IEC/BCC: Mass media, Outdoor media, Rural media, Advocacy media for NLEP Mass Media (TV, @DAVP/ 1 0.305 As per districts Radio & Press) Prashar demand, mass media Bharti rate campaign at district level Outdoor Media 1 1 0.150 As per districts (Hoarding, Posters, demand, Outdoor Banners & Leaflets) media at district level Rallies at district level @4000/ 4 0.160 As per districts rallies demand, School Rallies @4000/each IPC activities- School @5000/quiz 4 0.200 Quiz activity at school Quiz level @5000/quiz Folk shows @4000/ show 4 0.160 Folk show activity @4000/ show at district level IPC Meeting @700/ 25 0.175 Ad per district meeting demand, IPC meeting at district level @700/meeting Advocacy Meeting @5000/ 2 0.100 Advocacy meeting meeting @5000/ meeting IEC/BCC activities 11.18 under NPCB State level IEC for Minor State @Rs.10 lakh and for Major State @Rs. 20 lakh 11.18.1 under NPCB&VI For Eye Donation 1 1 0.20 Approved Fortnight For World Sight Day 1 1 0.10 Approved For World Glaucoma 1 1 0.10 Approved Week 11.19 IEC/BCC activities under NMHP
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11.19.2 Awareness 50000 1 0.50 Approved generation activities in the community, school, workplaces with community involvement 11.20 IEC/BCC activities under NPHCE 11.20.1 IPC, group activities 10000 1 0.10 Approved and mass media for NPHCE 11.20.2 Celebration of days ie 10000 1 0.10 Approved international day of older persons 11.21.1 IEC/BCC for NTCP For wall painting & 500 706 3.5 IEC through signages signages & wall painting Other IEC/BCC 1 1 1.0 Rs. 1.00 lac for activities IEC/BCC activities 11.22 IEC/BCC activities under NPCDCS 11.22.2 IEC/BCC for State 40000 1 0.4 Approved NCD Cell 11.22.3 IEC/BCC activities for 5000 40 2.0 Approved for universal screening of IEC/BCC activities @ NCDs Rs. 5000/facility 11.24 Other IEC/BCC activities 11.24.1 IEC activities for 25000 21 5.25 Rs.25000/HWC-SHC Ayushman Bharat as per the MoHFW Health & Wellness Operational Center (H&WC) Guildelines of CPHC. 11.24.4 Any Other IEC/BCC activities 11.24.4.1 IEC/BCC under 100000 1 1.0 For IEC/BCC NRCP: Rabies activities awareness and Do's and Don’ts in the event of Animal Bites 11.24.4.2 IEC/BCC under 10000 1 0.1 Approved NOHP 11.24.4.3 IEC/BCC under 100000 1 1.0 For IEC/BCC NVHCP activities 11.24.4.4 IEC on Climate 100000 1 1.0 For IEC/BCC sensitive diseases at activities block, district & state level-Air Pollution, Heat and other relevant climate sensitive diseases Total Budget 24.77
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Chapter -14 Quality Assurance & Kayakalp
QUALITY ASSURANCE
Quality Assurance program was launched by Ministry of Health & Family Welfare; Government of India in the year 2013 to meets the need of Public Health System in the country. This program was initiated to improve the poor quality of health care services in public health facilities. Regular assessment of health facilities by their own staff and state and ‘action- planning’ for traversing the observed gaps is the way in improving the quality of health care services in our health facilities.
In this program, health facilities have to do their periodic internal assessment against ministry defined departmental checklists for DH/SDH, CHC, PHCs and UPHC. After each assessment, facility will do gap analysis and on the basis of this gap analysis, action plan will be prepared for closing these gaps. When facility scores more than 70% and fulfilling certain criteria, they will contact DQAC for assessment. When facility scores more than 70% in DQAC assessment, they will submit the report to SQAC for State level assessment of the facility.
KAYAKALP
The Swachh Bharat Abhiyaan launched by the Prime Minister on 2nd October 2014, focuses on promoting cleanliness in public spaces. Cleanliness and hygiene in hospitals are critical to preventing infections and also provide patients and visitors with a positive experience and encourages moulding behavior related to clean environment. To complement this effort, the Ministry of Health & Family Welfare, Government of India launched a National Initiative (KAYAKALP) to give Awards to those public health facilities that demonstrate high levels of cleanliness, hygiene and infection control. Cash Award will be given to winner health facilities that score 70 % or more in each level of assessment.
The awards would be distributed based on the performance of the facility on the following Seven Thematic Areas: 1. Hospital/Facility Upkeep, 2. Sanitation and hygiene, 3. Waste Management, 4. Infection control, 5. Support Services, 6. Hygiene Promotion and 7. Cleanliness outside boundary wall.
The award will be given in four categories-
1. Best District Hospital in State 2. Best Sub District Hospital (SDH)/ Community Health Center (CHC) in State 3. Best Primary Health Center (PHC) in each district. 4. Best Health & Wellness Center (HWC) in each district.
Sr. No. Award Category Prize Money 1. Best DH 50 Lakhs 2. Commendation Award for DHs 03 Lakhs 3. Best SDH/CHC 15 Lakhs 4. Runner-up SDH/ CHC 10 Lakhs 5. Commendation Award for SDH/ CHCs 01 Lakhs 6. Best PHC from Each District 02 Lakhs
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7. Commendation Award for PHCs 0.5 Lakhs 8. Best Health & Wellness Center (HWC) in each 01 Lakhs district.(applicable where ≥10 sub centres operationalized as HWCs in one district)
9. Commendation Award for HWCs 0.25 Lakhs NOTE: According to the ministry guidelines of Kayakalp, the winner Hospital in previous year would have to show an improvement in their score by at least 5% from previous year score. If the winner Hospital does not meet the said criterion, then it would only receive the commendation award.
Tehri-Fund Allocation under Quality Assurance & Kayakalp New FMR Old FMR budget Head Amount Remarks code code approved (Rs. In Lakhs)
Quality
Assurance 16.1.2.2.3 B15.2.1 District Quality 1.20 Mobility support for DQAU @ Rs. Assurance Units 10,000 per month x 12 months = Rs. (Monitoring & 1.20 Lakhs. Supervision) 16.1.2.1.11 B15.2.2 District Quality 0.077 Review meeting of DQAC (quarterly) Assurance Unit @ Rs. 1925 per meeting for 4 (Review quarters = Rs. 7700. Meeting) 16.1.4.2.1 B15.2.2 District Quality 0.48 Budget approved for - Assurance Unit 1.Operational cost of DQAU @ Rs. (Operational 2000 per month x 12 months = Rs. cost) 0.24 lakhs. 2. Operational cost for Quality Manager @ Rs. 2000 per month x 12 months = Rs. 0.24 lakhs.
13.2 Kayakalp 9.5.25.3 B15.2.7.1 Kayakalp 0.60 Approved for following activities- Trainings 1) One day district level Kayakalp cum SBA training @ Rs. 60,000 x 1 = Rs. 0.60 Lakhs. (Note: Only one training under Kayakalp for all the DHs, SDHs, CHCs, PHCs and HWCs in district)
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13.2.1 B15.2.7. Assessments 1.64 Approved for following activities- 2 1. Internal Assessment of 01 DHs @ Rs. 2000 per facility for 2 quarters = Rs.4000. 2. Internal Assessment of 11 SDH/ CHCs @ Rs. 1000 per facility for 2 quarters = Rs. 22,000. 3. Internal Assessment of 23 PHCs/ APHCs @ Rs. 500 per facility for 2 quarters = Rs. 23,000. 4. Peer Assessment of 23 PHCs/ APHCs @ Rs. 5000 = Rs. 1.15 Lakhs. (Note: Peer assessment of PHCs/ APHCs/ HWCs in district will be done by different block's teams within district. Block teams will be decided by CMO. One block team will do peer assessment of other block's PHCs/ APHCs/ HWCs)
Total 3.997
Summary of Approval (QA and Kayakalp)
Total approval (Rs. In FMR code Budget Head Lakhs)
U. 9 Training & Capacity Building 0.6
U. 13 Quality Assurance 3.397
3.997 Total (Rs. in Lakhs)
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Chapter -15 HMIS/ MCTS and RCH Portal
Health Management Information System (HMIS)/ Mother & Child Tracking System (MCTS) and Reproductive and Child health care Portal (RCH Portal):
,
"An augmented version of MCTS” application has been designed for early identification and tracking of the individual beneficiary throughout the reproductive lifecycle.
Application facilitates to ensure timely delivery of full component of antenatal, postnatal & delivery services and tracking of children for complete immunization services.
Ministry of Health & Family Welfare, GoI has introduced an innovative web based application called Mother and Child Tracking System (MCTS) with the objectives to :
(i) Facilitate timely delivery of all services to pregnant women and children (ii) Strengthen health care service delivery system, (iii) Improve service delivery coverage and (iv) Monitoring mechanism at all level.
Regular reporting has been ensured on MCTS portal in Uttarakhand State. Due to the changing data requirements of National Reproductive and Child Health (RCH) programmers, the Ministry has designed RCH portal, wherein, Eligible Couples, Pregnant Women and Children will be tracked for health care service delivery to them. RCH portal has been designed to meet the requirements of the RMNCH+A program by incorporating additional functionality and features of the MCTS.
The RCH portal will transit MCTS portal in phase manner. The RCH portal will further strengthen health care delivery system; improve service coverage and monitoring mechanism. The use of this information for early identification and management of basic complications during pregnancy, childbirth and post-partum period at field level will help in reducing the maternal, neonate and infant mortality rates.
HR support for individuals who are unable to meet this important benchmark.
1. Concerned Facility Incharge and Program Officers at District/ Block level will have to monitor the implementation status of RCH Portal and the performance of HR and share the feedback on Challenges/ enhancements required on fortnightly basis.
2. Ensure all pregnant women and Infant data against target for each subcenter/Facility should be captured in RCH Register by ANM.
3. Registration coverage of pregnant Women and Children on RCH portal should be at least 85% of the Target.
4. Uploading of ANM and ASHA records with validated mobile numbers on RCH Portal should be 100% percent of total filled positions of ANM and ASHA.
5. Registration of pregnant women and children with validated mobile numbers of self/Husband (in case of Pregnant women) or parent in case of Children) on RCH portal should be at least 70% of Target.
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6. Registration of all pregnant women with her validated Adhar numbers should be done on RCH portal.
7. Timely Registration and follow up is essential for effective implementation of RCH portal in the District. To avoid time lag, it is suggested that service delivery records of beneficiaries may be updated in service delivery point itself.
8. Further it is hereby instructed that performance of the Data Entry Operators may be evaluated on quarterly basis against the benchmark of Average 125 records per day and minimum 2500 new registrations/ Service updations per month reported by them on RCH portal. State may not consider to continue.
All the Districts/Blocks should submit their Minutes of Meeting of every training of HMIS/MCTS to State HQ.
Health Management Information System (HMIS) :
1. Overview of HMIS Portal.
The HMIS (Health Management Information System) web portal was launched by the Ministry of Health and Family Welfare (MoHFW) on 21st October, 2008 to enable capturing of public health data from both public and private institutions in rural and urban areas across the country. The portal is envisaged as a “Single Window” for all public health data for the Ministry of Health and Family Welfare. The MoHFW initially rolled out the HMIS up to the District Level and now expanded upto the Sub District/Block level, including facility wise manual data collection by Front line workers. All 13 Districts are reporting their monthly performance on regular basis.
2. Objectives.
The System is operational with the following aims:
1. To enable the data entry at Block Entry point (CHC/PHC).
2. To enable user to preview, compare, modify and forward data to the next level.
3. The data stored by using the Data Entry Application is transformed and loaded into data marts which is further used for Statistics, Analytical & Ad‐hoc reporting.
4. To consolidate the data entered at sub‐district level/block, district level, at the state and further at national level and store it into the central database.
Note: Data Report has to be validated and duly signed by concerned MO I/c on monthly basis mandatorily and duly signed copy has to be submitted to the district level on monthly basis.
All the Districts/Blocks should submit their Minutes of Meeting of every training of HMIS/MCTS to State HQ.
Budget approved for Operation and Management of HMIS/MCTS under ROP 2020-21 is as under:
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New Old FMR Budget Head Physical Amount Remarks FMR Quantity/ Approved Target (in lacs)
9.5.26.2 B15.3.1.4.2 Training cum - 0.36 Budget approved for Review meeting Training cum Review for HMIS/MCTS meeting for HMIS/MCTS /ANMOL if at district Level launched, including incidental expenses as per RCH rules. 9.5.26.3 B15.3.1.4.3 Training cum 211 5.06 Budget approved for Review meeting Training cum Review for HMIS/MCTS meeting for HMIS/MCTS @ Rs. at Block Level. 200 per ANM for 12 months 16.3.2 B15.3.1.5.2 Mobility support - .80 Approved Rs for for HMIS/MCTS Mobility at District District Level. Levels, TA/DA should be as per extant rules. 16.3.3 B.15.3.2.7 Operational cost 12 1.44 for HMIS & MCTS (incl. Internet connectivity; AMC of Laptop, printers, computers, UPS; Office expenditure; Mobile reimbursement)
Budget approved 1.44 Lakh for Internet Connectivity @1000 per month for 12 months for 12 Data Entry Points through LAN/Data Card. This is subject to 100% Facility based reporting on HMIS & MCTS/RCH Portal and improvement in data quality thereof. These are indicative rates, final rates are to be arrived at as per GEM rate contract or after competitive bidding following Government protocols. 16.3.3 B.15.3.2.7 Operational cost 230 2.76 for HMIS & MCTS (incl. Internet connectivity; AMC of Laptop, printers, computers, UPS; Office expenditure; Mobile reimbursement)
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Budget approved 2.76 Lakh for CUG connection @100 per month for 12 months for ANM. Since a few HVs are rendering services as an ANM, therefore districts as hereby allowed to provide Rs 100/- ANM/HVs for running their CUG. 1. Entry of validate mobile number, Adhaar Number and Adhaar linked account number of ANM and ASHA on RCH portal. 2. Entry of validated mobile number and Adhaar number of minimum 60% of benificiaries on RCH portal. 3. Entry of Minimum 80% village profiles (service catchment/hamlet/Unit of HSC) on RCH portal. 4. Registration of more than 60% beneficiary (eligible couple, pregnant women and children) on pro-rata basis on RCH portal. 5. Delivery of due services to more than 50% beneficiaries (Mother and child) on pro-rata basis and its updation on RCH portal. Continuation/ Extension of the activity would be based on improvement in registration of pregnant women and children and data of service delivery and availability of updated and validated information related to ANM, ASHAs and beneficiaries on RCH portal. Procurement should be based on Competitive bidding following government protocols. If the tablet being provided to ANMs have provision for talk time then District must ensure that these ANMs are reimbursed for phone/mobile only once. Further District may ensures proper process of authentication/Validation of Adhaar number of benificiaries before releasing the incentive of ANMs /ASHAs.
SUMMARY OF APPROVALS: HMIS/MCTS
Budget Approved FMR Code Budget Head (Rs. In lacs)
U.9 Training & Capacity Building 5.42
U. 16 Programme Management 5.00
Total (Rs. In lacs) 10.42
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Chapter -16 Free Essential Drug Services and Drug Warehousing
The impoverishing effects of health care costs on account of private spending are well known, as is the fact that drugs contribute over 70% of Out of Pocket Expenditure (OOPE) at the point of care. Making free drugs available in public health facilities therefore becomes an imperative.
U6: Procurement
In FY 2020-21, 30% of total budget allocated under FEDS has been allocated to the districts. The allocated funds are to be utilized for procurement as per following provisions of FEDS:
1. Medicines, surgical items and sutures listed in Uttarakhand Essential Drug List 2016 are to be procured from allocated funds. 2. All drugs procured, distributed and prescribed under this initiative shall be generic drugs. 3. Quality Assurance of procured medicines, surgical items and sutures for this Initiative would be extremely critical. All these drugs must be sourced from Good Manufacturing Practices (GMP) compliant manufacturers through robust procurement mechanisms, and post supply testing of every batch before distribution. 4. Prescription audit mechanism would be required to be put in place to ensure prescription of generics and rational use of drugs. Ensuring rational use of drugs and preventing all forms of wastage is extremely important under the initiative.
U. 14 Drug Warehousing and Logistics
Supply Chain and Logistics System for Drug Warehouse
Transportation of Drugs to Health Care Facilities
All medicines must be stored and handled in accordance with the requirements of the products-drugs, vaccines, serum, etc. in order to maintain potency and effectiveness. Drugs that require to be maintained at temperatures between 2° to 8°C must be transported with proper cold chain maintenance. Storage outside the recommended temperature range can result in chemical and/ or physical changes to the product which may lead to a loss of efficacy and/or altered patient response with potential to cause harm. When medicines are transported between Drug Warehouse and health institutions, the following points should be taken into account:
Drugs and vaccines should be kept in proper boxes and delivered to the facility in appropriate vehicle. Drugs and vaccines should only be handed over to an authorized representative of the facility. Drugs and vaccines containers must not be left unattended during transit On arrival in the facility, the supply should be rechecked with respect to the delivery challan. Any discrepancy must be reported to Officer In-charge of State CMSD/CMO CMSD immediately If there is any difficulty in handing over the drugs, it must be reported to the State CMSD/CMO CMSD and the State/District Head Quarter with justification.
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The transport process should be designed to maintain the integrity and quality of the drug products. Wherever stipulated all the controlled storage conditions required during transit must be followed. Loading and unloading activities should be done in a manner that preserves the quality of the drugs. Transportation of medicines requiring cold storage conditions
All concerned Warehouse staff needs to ensure the following:
During transportation of such medicines, it must be ensured that the temperature range is maintained between 2°C and 8°C Handling and transportation time to the destination should be kept to a minimum to ensure that the medicines retain optimal efficacy. If portable fridges/Ice Lined Refrigerators are used for transportation of such medicines it is essential that temperature range is maintained between 2°C and 8°C and a power supply is available to access in an emergency. A temperature monitoring device should be used to record the minimum and maximum temperature range of the refrigerated medicine during the transportation process. The temperature monitoring device should be placed in the middle of the package. Temperatures during transportation should be recorded in a Log Book. The temperature monitoring device must be checked on arrival at the destination. If transport is within a single building, and transit time is less than 15 minutes, then the products should be transported in an insulated container (cool bag). Allocated funds are to be used only for payment of fuel utilized in transportation of medicines Along with fuel bills it would be mandatory to attach the Issue voucher of Medicines Only one fuel bill will be cleared against one issue voucher In case of transportation of Medicines by Government vehicles, it would be mandatory to attach the log book of the said vehicle
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Chapter -17 Free Diagnostic Services
Free Diagnostics Services was rolled out in Uttarakhand on 17th October, 2016 vide G.O.No-(1)/XXVVIII-4-2016-113/2015.
In Phase1- Services were provided to the MSBY card holder for OPD patients. 30 free tests were available at District and sub district hospitals. 28 free tests were available at the CHC level.
In Phase II, State is providing 56 free tests at District/ Sub district Hospitals against the G.O. issued on 31st May 2019. The above cited G.O. is in the process of slight amendment, with 19 free tests at Primary Health Centers and 07 free tests at Sub center. Moreover, it is pertinent to state that currently State is not providing CT scan services under Free Diagnostic Services, however, under Teleradiology services, CT scan reporting is being provided free of cost to the patient. Since November 2017, Teleradiolgy services are functional at 35 health facilities of the state. State has procured 21 Five Cell Counter, 10 CR System, 13 Auto Immuno Analyzer and 13 Electrolyte Analyzer. Procurement of 05 X-Ray (300 MA) is under the process.
In the quest of revamping and revitalizing exiting diagnostic services in Uttarakhand, following proposal has been made in the PIP for financial year 2020-21:
SN Activity Name Budget Proposed Remark/Justification 1 Setting up Mother 1-Infrastructure The budget has been proposed with the Labs cost @ Rs 50 lacs rationale of building up Mother Labs in per lab Garhwal Division, covering 07 districts of Garhwal division (state has two division) 2- Infrastructure and in Kumaon division, comprises of 06 cost @ 10 lacs per districts. Identification of land/ health Hub lab facility is in process and will apprise the Ministry accordingly.
For Garhwal Division: a) One at Dehradun, which will cater the diagnostic need of district Dehradun, Haridwar, Tehri & Uttarkashi b) Second at Srinagar Garhwal, catering the diagnostic need of District Rudraprayag, Chamoli, Pauri
For Kumaon Division: a) One at Haldwani (District Nainital) catering the diagnostic need of district Nainital, Udham Singh Nagar & Champawat b) Second at district Almora, catering the diagnostic need of Almora, Bageshwar and Pithoragarh
2 Setting up of 15 Hubs State has proposed to set up 15 Hubs at
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different locations, based on the existing patient load (as per HMIS). The initiative comprises of 09 Diagnostic Hubs in various districts (excluding 04 districts, where the Mother Labs have been proposed) and 06 Hub in various health facilities, having heavy patient load. These facilities are as follows: 1. Sub District Hospital, Rishikesh, Dehradun 2. Sub District Hospital Roorkee, Haridwar district 3. Sub District Hospital, Kotdwar, Pauri district 4. Sub District Hospital Kashipur, Udham Singh Nagar district 5. Combined Hospital Sringar, Pauri District 6. Base Hospital, Haldwani, Nainital district 3 Setting up of 100 As per the patient load, exhibiting in spokes HMIS, state has proposed to set up 100 spokes in different health facilities, across the state. For the precise selection of the facilities; to be a spoke, state has sought opinion and suggestions from all the concerned district health officials. On the basis of the feedback, concerted action will be taken.
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FMR Code: 6.4.1 (Pathology)
It is pertinent to state that the state will resort to outsource or PPP model for providing high level tests, till the time it strengthen its diagnostic edifice.
Tele-radiology centre (TRC) There are 35 such centres selected in this project which are equipped with radiology equipments, having digital capabilities or ways to convert the radiology images into digitally transferrable images of acceptable resolution ( As per DICOM specifications). Main Radiology equipment under this arrangement are as below, depending on availability of equipment at the hospital: X-RAY ( at all locations) CT ( At Select Locations) MRI ( At Select Locations
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Chapter -18 Blood Services
Blood transfusion services play a vital role in a health care delivery system. Under this, various activities are taken up by the state for ensuring access to safe blood and blood products. State of Uttarakhand is implementing various activities to address issues of blood collection, access and quality management practices. It is mandatory that each unit of blood is tested for TTI and provided free of cost to patients after TTI testing to reduce OOPE (Out of Pocket Expenditure). For testing of blood, various consumables like kits and blood bags and equipments also are required. It is essential that the equipment of the blood banks are kept functional all the time. Collection of blood, transport & storage of blood are the other aspects of the program activities.
As the blood transfusion services play a vital role in the health care delivery system, the state is making continuous efforts to make safe blood and blood products available to all who need it at the right time, in required quantity and with best possible quality. In Uttarakhand (UK), the availability of blood is ensured through a network of 40 licensed blood banks out of which 21 are in govt. sector and 06 licensed blood storage centers.
State Blood Cell was started in the Financial Year 2015-16 to redress the blood transfusion services in the state as the blood transfusion service is an important part of the National Health Service as there is no alternative to human blood and its components. Due to the availability of blood bank or blood storage center, maternal death can be reduced and it is also useful in accident and emergency situations.
The main objective of state blood cell is:- Review the status of blood services in the state and address the gap to ensure availability and accessibility of safe and quality blood Provide adequate infra-structure, equipments, trained and adequate power for Well- organized Blood Services. It’s work to ensure equitable blood supply, distribution. To provide blood from blood donor to the needy person effectively and efficiently with maintaining the quality of blood under the blood transfusion service, for which blood cell is organizing and providing the necessary equipments, human resources, training, basic structure and Consumable in the Blood banks and Blood Storage Centers.
1. Service Delivery – Facility Based - NIL 2. Service Delivery – Community Based - NIL 3. Community Interventions - NIL 4. Untied Fund - NIL 5. Infrastructure
Construction work National Health Mission is continuously providing fund for the up gradation of blood bank and Blood component separation Unit.
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Up gradation of blood bank or new blood bank is required in facilities who perform all types of surgery, patients with excessive thalassemia or hemophilia are registered in the hospital (who require blood on time), warm and humid place (due to which there is a possibility of dengue and other diseases). (In Lakhs) New Old FMR Budget Head Unit Quantity Amount Remarks FMR Code Cost /target Approved Code (Rs) U.5 Infrastructure 00.00 5.3.3 B.4.1.5.4.1 Blood Bank/Blood Storage 0 0 00.00 Center/Daycare care center for Haemoglobinopathies. 6. Procurement
Equipments
For the up-gradation and strengthening of blood bank or Blood Storage Center, National Health Mission is providing fund for procurement of necessary equipment required for said purpose.
Consumables NHM is also providing funds for the procurement of consumables for blood bank. Now GoI has clearly instructed to reduce OOPE (Out of Pocket Expenditure) of patients and provide blood free of cost to all government facility patients (by all district level govt. blood banks) after processing of blood.
Equipment Maintenance for Blood Bank/Blood Storage Center License Blood bank license is valid for 5 years and Blood storage center license is valid for 2 years, and it is mandatory for facilities having BB/BSU to apply for renewal of license before three months of the validity. (In Lakhs) New Old FMR Budget Head Unit Quantity/ Amount Remarks FMR Code Cost target Approved Code (Rs) U.6 Procurement 0.00 6.1.1.9.1 B.16.1.1.1 Equipments for 0 0 0.00 blood bank/BSU's 6.1.3.1.e - Any Biomedical 0 0 0.00 GOI has approved equipment budget of Rs. 0.00 maintainance(Please Lakhs for the Specify) maintenance/AMC of DH Baurari blood bank equipments, Calibrated equipments are necessary for the License of blood bank. 6.2.7.1 B.16.2.11.1 Drug and supplies 0.00 1 0.00 GOI has approved for blood services budget of Rs. 0.00 Lakhs for DH Baurari blood
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bank for regular supplies of quality test kits, blood bags, barcode printer consumables and other consumables for the blood banks because tehri blood bank is running in PPP mode. District has to ensure that state blood bank is providing blood free of cost after processing to all govt. facility patients.
7. Referral Transport - NIL 8. Service Delivery – Human Resources
Human resource Blood banks and blood storage centers in the state are required to execute 24 x 7 to provide blood to the needy. In this order, Human Resources were required in Blood banks and Blood Collection Centers to work in 24x7, for which National Health Mission is providing necessary HR support to run blood bank 24x 7. . Approved amount present in HR Annexure.
9. Training & Capacity Building - NIL 10. Review, Research, Surveillance & Surveys - NIL 11. IEC/BCC
IEC play a vital role in blood donation. To sensitize and mobilize important stakeholders who would in turn facilitate voluntary blood donation camps. The important organizations involved are educational institutes (colleges, schools and universities), govt. departments & religious organizations. GoI has approved fund for the recognition of the voluntary blood donors (Coffee Mugs with logo & quotes related to voluntary blood donation).
(In Lakhs) New Old FMR Budget Unit Quantity/ Amount Remarks FMR Code Head Cost target Approved Code (Rs) U.11 IEC/BCC - 11.10.1 B.10.7.4.5.1 IEC/BCC 00 1 - GOI has approved budget Through for recognition items @ Rs.
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voluntary 40 per item for IEC purpose blood for blood bank. donor's Procurement is being done from State Level and it will be supplied to districts soon.
12. Printing - NIL 13. Quality Assurance - NIL 14. Drug Warehousing and Logistics - NIL 15. PPP - NIL 16. Programme Management - NIL 17. IT Initiatives for Strengthening Service Delivery
e-Raktkosh With the aim of strengthening and modernization of blood transfusion service in the state, all the blood banks are linked to each other through e-Raktkosh system. Through e-Raktkosh online system, the status of available blood units in each blood bank, number of blood unit collected, their blood groups, and real time (live) blood stock can be known at any level. With the help of the application, the people in need of blood and blood products can save the critical time required for blood transfusion services. The e-Raktkosh is known to store the live stock position of the blood banks, and also monitor the stock of the consumables content in the blood bank. Black marketing of blood units can be curbed through the e-Raktkosh system. e-Raktkosh system can store the record of donor screening, donor history and helps in tracking of donor at any time, and will also prevent a sero- reactive donor from donating blood in future. This will help in the treatment of large number of hepatitis-B and hepatitis-C patients in the state and provide proper treatment to them. Maternal Death Rate can be reduced through e-Raktkosh system and it is also useful in accident and emergency situations. The main objective of the e-Raktkosh system is to promote voluntary blood donation in the state, reduce the waste of blood and complying with guidelines and regulations. In this order, the availability of blood in the blood bank is being shown by all the blood banks in the e-Raktkosh portal. This can be seen by everybody from any place at any time through Website: www.eraktkosh.in or e-raktkosh application (Android/Apple).
(In Lakhs) New Old Budget Head Unit Quantity/ Amount Remarks FMR FMR Cost target Approved Code Code (Rs) U.17 IT Initiatives 0.00 for Strengthening Service Delivery 17.4 B.14.15 e-Raktkosh – 00 1 0.00 District has to ensure that all Refer to Govt. blood banks present in strengthening district are live in e-Raktkosh
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of blood and Private & charitable blood services banks are updating their blood guidelines. stock on daily basis in e- Raktkosh.
18. Innovations (if any) - NIL
Summary of Approvals : Tehri (Blood Cell)
Total Amount Approved FMR Budget Head (In Lakhs) U.6 Procurement 0.00
Total 0.00
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Chapter -20 Integrated Disease Surveillance Programme
Integrated Disease Surveillance Programme (IDSP) is a decentralised disease surveillance programme for monitoring of disease trends and to detect and respond to outbreaks in early rising phase through trained Rapid Response Team (RRTs). The main objective of IDSP is to generate/detect early warning signals of impending outbreaks and to initiate effective responses in a timely manner.
Targets: Data Reporting on Syndromic, Presumptive & Laboratory formats on IDSP Portal - 100% Consistency & timeliness of reporting - 100 %
Data reporting and Outbreak Surveillance & response:
Weekly collection, compilation, analysis of SPL (Syndromic, Presumptive & Laboratory) data and dissemination of feedback reports should be done at District level. Generation of Early Warning Signals for timely detection of Outbreaks. District have RRT (Rapid Response Team) consisting of Epidemiologist, Microbiologist/ Pathologist, Physician/ Pediatrician to investigate and mitigate the impact of epidemics. Also inclusion of Food Safety Officers (for Food borne disease OBs) and Veterinary Officers (for Zoonotic disease OBs) in District RRT for quality outbreak investigations. Media alerts are being regularly verified. In 2019, Data reporting on IDSP Portal in Syndromic, Presumptive and Laboratory formats is 82%, 91% and 87% respectively.
U.6 Procurement
As per directions of Government of India, District labs to be strengthened as District Public Health Laboratories at each district for early detection and diagnosis of epidemic prone disease to minimize the impact of outbreak. In this regard, One new DPHL approved and to be strengthened in FY 2020-21 at District Hospital Tehri.
Under FMR Code 6.1.1.15.1 (Non-recurring costs on account of equipment for district public health labs requiring strengthening), Total amount Rs. 16.20 lakh is approved In FY 2020- 21 for new DPHL strengthening at District Hospital Tehri.
FMR Budget Head Unit Cost Physical Amount Remarks Target approved in FY 2020-21 (Rs. In Lakh) U.6 Procurement 16.20
Non-recurring Budget approved costs on account of for for new DPHL at equipment for District Hospital Rs. 6.1.1.15.1 District public 1 16.20 Tehri for Non- 16,20,000 health labs recurring costs on requiring account of strengthening equipment for district public health
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labs requiring strengthening
U.7 Referral Transport ------
Service Delivery- U.8 ------Human Resource
Training and U.9 ------capacity building
U.10 Review, Research, Surveillance and ------Surveys
U.11 IEC/BCC ------U.12 Printing ------
U.13 Quality Assurance ------
Drugware Housing U.14 ------and Logistics
U.15 PPP ------
U. 16 Programme Management
Under Programme Management total amount of Rs. 2.16 Lakh approved for following :
Rs. 1.08 Lakh for Mobility, Travel Cost, POL etc. during outbreak investigations and field visits for monitoring programme activities approved @ Rs. 9000 per month for 12 months Rs. 1.08 Lakh for Office expenses e.g. telephone, fax, Broadband Expenses & Other Miscellaneous approved @ Rs. 9000 per month for 12 months
FMR Budget Head Unit Cost Physical Amount Remarks Target approved in FY 2020-21 (Rs. In Lakh)
U.16 Programme Management 2.16
16.1.3.3.8 MOBILITY: Travel Cost, Rs. 9000 12 1.08 @Rs. 9000 Per POL, etc. during outbreak per month months Month for 12 investigations and field months visits for monitoring programme activities at DSU on need basis
16.1.4.1.5 Office expenses on Rs. 9000 12 1.08 @Rs. 9000 Per
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telephone, fax, Broadband per month months Month for 12 Expenses & Other months Miscellaneous Expenditures
U.17 IT initiatives for ------strengthening Service Delivery
U.18 Innovations (If any) ------
Note : Human Resource budget is available in separate chapters for FMR 8 and 16
Summary of approvals FY 2020-21 NHM_IDSP_Tehri
Amount approved in FY FMR Budget Head 2020-21 (Rs. In Lakh)
U.6 Procurement 16.20
U.16 Programme Management 2.16
Total 18.36
Note :
Human Resource budget is available in separate chapters for FMR 8 and 16
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Chapter -21 National Vector Borne Disease Control Programme (NVBDCP) National Viral Hepatitis Control Program (NVHCP)
The National Vector Borne Disease Control Programme (NVBDCP) is for prevention & control of vector borne diseases like- Malaria, Dengue, Chikungunya, Japanese Encephalitis (JE), Kala-azar and Lymphatic filariasis.
Malaria-
Reduction of the incidence of malaria to less than 1 case per 1000 population (Annual Parasite Indicator -API) annually in all PHCs and their Sub Centres by the year 2020. Annual Blood Examination rate (ABER) should be 10% of total population. Malaria case based surveillance Interrupt malaria transmission by the year 2020. Prevent the re-establishment of local transmission of malaria in areas where it has been eliminated and maintain malaria-free status by the year 2022 and beyond. Dengue/Chikungunya
Objectives:
To prevent and reduce morbidity and mortality due to Dengue/CHK. Identify early cases of Dengue/CHK to prevent impending outbreaks. Activities:
Prevention of dengue vector (Aedes aegypti) breeding through source reduction activities larva control measures Adult mosquito control Awareness amongst general public. Effective epidemiological surveillance, Uniform data collection, Timely Reporting and complete line listing. Use of Dengue/ chikungunya awareness card with the collaboration of Education Department. Intersectoral collaboration for participation of various departments in dengue control drive. Ensure compliance of standard dengue clinical management guideline at all health facilities. Japanese Encephalitis/Kala azar / Filaria
Enhance surveillance for identification of cases. Enhance vector surveillance in reporting areas.
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U.3 Community Intervention- Incentive for Blood Slide Preparation :
The incentive given to ASHAs for Blood slide preparation of all fever cases in two slabs: Rs. 15 for preparing Blood smear / use of RDT and Rs. 75 for ensuring complete radical treatment. The target of blood slide preparation for District Tehri Garhwal is 3000 Blood slides.
FMR Amount approved Unit Physical in FY New Budget Head Remarks Old FMR Cost Target 2020-21 FMR code (Rs. In code Lakh)
Community U.3 1.45 Intervention 3.1.1.4.1 F.1.1.b ASHA Incentive/ 15.00 3000 Target for Blood Slide Honorarium Blood Preparation by ASHA Slides – 3000 Blood slide 0.45 (3000 blood slide*15=Rs. 0.45 lakh)
Dengue & It includes source Chikungunya: reduction activities to Vector Control, be carried out by 3.2.5.2.1 F.1.2.f environmental 1.00 ASHA/Volunteer and management & Hand operated fogging machine fogging machines
U.6 Procurement
For Elimination of malaria and Prevention and control of Dengue, budgets are approved by GOI for listed following commodities.
District should minimize the risk of stock-outs through effective management of logistics systems, which should include appropriate economic order quantity, procurement period, stores and inventory and product demand. These procedures should include the establishment and maintenance of reliable inventory management, “First-Expiry/First-Out” (FEFO) stock control systems.
FMR Amount approved Unit Physical New Budget Head in FY Remarks Cost Target FMR Old FMR code 2020-21 code (Rs. In Lakh) U.6 Procurement 1.05
6.2.12.9 B.16.2.11.3.i Temephos, Bti Procurement of (AS) / Bti (wp) (for Larvicide 1000.0 0.05 polluted & non polluted water)
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6.2.12.10 B.16.2.11.3.j Pyrethrum extract Procurement of 2% for space 1350.0 0.50 Pyrethrum spray extract 2%
6.2.12.12 B.16.2.11.3.l Procurement of Malaria rapid diagnostic kits RDT Malaria – bi- valent (For Non 20.00 0.50 (Antibody based Project states) RDT is not recognized for malaria confirmation)
U.9 Training and Capacity building
Under Training and Capacity building, 1 batch of 1 day training for 50 ASHA @ Rs25000.00/- is approved in FY 2020-21.
FMR Amount approved Unit Physical in FY New Old Budget Head Remarks Cost Target FMR FMR 2020-21 code code (Rs. In Lakh)
Training and U.9 - - 0.25 - Capacity building
25000.00 1 0.25 1 batch of 50 Training / Capacity 9.5.12.1 ASHAs @ Building (Malaria) 25000/batch.
U.10 Review, Research, Surveillance and Surveys
A rapid Diagnostic test kit for confirmation of Dengue is not recommended due to its low sensitivity and specificity so a suspected case of dengue has to be tested by ELISA technique. For ELISA testing, the blood sample of suspected case will be sent to nearest SSH.
U.11 IEC/BCC
IEC/ BCC is an integral part of the malaria elimination and prevention and control of Dengue. As awareness among general public, community participation is a most important tool for prevention and control of Dengue. The IEC/ BCC materials could include pamphlet, hoardings, posters, Banners, signboards and also social media.
FMR Amount approved in Unit Physical New Budget Head FY 2020-21 Remarks Old FMR Cost Target FMR (Rs. In code code Lakh)
U.11 IEC/BCC 0.80
11.15.1 B.10.6.9.a IEC/BCC for 0.30 Rs. 0.30 lakh for
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Malaria IEC/BCC for Malaria
IEC/BCC for Rs. 0.50 lakh for Social IEC/BCC for Social 11.15.2 B.10.6.9.b mobilization 0.50 mobilization (Dengue and (Dengue and Chikungunya) Chikungunya)
U.15 PPP The prevention and control of dengue requires close collaboration and partnerships between the health and non-health sectors (both government and private) and local communities. Inter-sectoral coordination should also play a key role in advocacy for the containment of malaria.
FMR Amount approved Physical New Budget Head Unit Cost in FY Remarks Old FMR Target FMR 2020-21 code code (Rs. In Lakh) U.15 PPP 0.10
Rs. 0.05 lakh PPP / NGO and for Inter 15.3.1 Intersectoral 10000.00 1 0.05 sectoral Convergence coordination meeting Rs. 0.05 lakh
for Inter Inter-sectoral 15.3.2 F.1.2.g 10000.00 1 0.05 convergence sectoral coordination meeting
U. 16 Programme Management
Monitoring & Evaluation –mere monitoring of impact and disease burden to close follow up of processes, outputs and outcomes. Monitoring provides the information and feedback needed to plan corrective action as and where necessary. The performance of the program is evaluated by independently conducted periodic surveys and qualitative assessments which provide measurements of a set of predetermined indicators. These include indicators like proportion of cases receiving timely case management, case based surveillance, and Indoor Residual Spray etc. 2 visit per week by district concern officer accordingly. Monitoring & Evaluation includes-
1. Hiring of vehicles at the state/District level with the norms of NHM 2. Supervision – TA/DA shall be applicable as per the norms of NHM 3. Epidemic Preparedness – For capturing early warning signals, Rapid Response Team etc 4. Procurement of Consumables items
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The effective control of Dengue and Chikungunya requires a strict supervision components viz. epidemiological situation, surveillance, case management etc.
Epidemic preparedness for containment of outbreak of Dengue.
FMR Amount approve Unit Physica New Old Budget Head d in FY Remarks Cost l Target FMR FMR 2020-21 code code (Rs. In Lakh) U.16 Programme 1.02 Management Rs. 0.15 lakh for Distt. Monitoring Tehri Garhwal for Supervision and 16.1. 1500 Monitoring & Evaluation of F.1.2.c Rapid Response 1 0.15 2.2.6 0 all VBD, Hiring of vehicles, (Dengue and TA/DA, Procurement of Chikungunya) Consumables items
Monitoring , Evaluation & Rs. 0.37 lakh for Distt. 16.1. Supervision & Tehri Garhwal for 3700 3.1.8 Epidemic 1 0.37 Monitoring & Evaluation of 0 Preparedness all VBD, Hiring of vehicles, (Only Mobility TA/DA, Expenses)
Rs. 0.50 lakh for Distt. 16.1. F.1.2. Epidemic 5000 Tehri Garhwal for Epidemic 1 0.50 5.3.8 d Preparedness 0 Preparedness for Dengue/ CHK
IT initiatives for U.17 strengthening ------Service Delivery
Innovations (If U.18 ------any)
Summary of approvals FY 2020-21 NHM_NVBDCP_Tehri Garhwal
Amount approved in FY FMR Budget Head 2020-21 (Rs. In Lakh)
U.3 Community Interventions 1.45 U.6 Procurement 1.05
U.9 Training and Capacity building 0.25
U.11 IEC/BCC 0.80
U.15 PPP 0.10 U.16 Programme Management 1.02 Total 4.67
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National Viral Hepatitis Control program (NVHCP)
Viral hepatitis is increasingly being recognized as a public health problem in India. Hepatitis B and C, the two main types of the five different hepatitis infections (A,B,C,D,E), are responsible for 96% of overall viral hepatitis related mortality.
Aims : 1. Combat hepatitis and achieve country wide elimination of Hepatitis C by 2030. 2. Achieve significant reduction in the infected population, morbidity and mortality associated with Hepatitis B and C viz. Cirrhosis and Hepato-cellular carcinoma (liver cancer). 3. Reduce the risk, morbidity and mortality due to Hepatitis A and E.
Key Objectives: 1. Enhance community awareness on hepatitis and lay stress on preventive measures among general population especially high-risk groups and in hotspots. 2. Provide early diagnosis and management of viral hepatitis at all levels of healthcare. 3. Develop standard diagnostic and treatment protocols for management of viral hepatitis and its complications. 4. Strengthen the existing infrastructure facilities, build capacities of existing human resource and raise additional human resources, where required, for providing comprehensive services for management of viral hepatitis and its complications in all districts of the country. 5. Develop linkages with the existing National programmes towards awareness, prevention, diagnosis and treatment for viral hepatitis. 6. Develop a web-based “Viral Hepatitis Information and Management System” to maintain a registry of persons affected with viral hepatitis and its sequelae.
Components The key components include: 1. Preventive component:
This remains the cornerstone of the NVHCP. It will include, a) Awareness generation b) Immunization of Hepatitis B (birth dose, high risk groups, health care workers) c) Safety of blood and blood products d) Injection safety, safe socio-cultural practices e) Safe drinking water, hygiene and sanitary toilets 2. Diagnosis and Treatment: a) Screening of pregnant women for HBsAg to be done in areas where institutional deliveries are < 80% to ensure their referral for institutional delivery for birth dose Hepatitis B vaccination. b) Free screening, diagnosis and treatment for both hepatitis B and C would be made available at all levels of health care in a phased manner. c) Provision of linkages, including with private sector and not for profit institutions,for diagnosis and treatment. d) Engagement with community/peer support to enhance and ensure adherence to treatment and demand generation.
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3. Monitoring and Evaluation, Surveillance and Research Effective linkages to the surveillance system would be established and operational research would be undertaken through Department of Health Research (DHR). Standardised M&E framework would be developed and an online web based system established.
4. Training and capacity Building: This would be a continuous process and will be supported by NCDC, ILBS and state tertiary care institutes and coordinated by NVHCP. The hepatitis induction and update programs for all level of health care workers would be made available using both, the traditional cascade model of training through master trainers and various platforms available for enabling electronic, e- learning and e-courses. Action Plan
There are 3 Model treatment centres (MTC) & 3 State labs (SL) approved and operational in state.
Model treatment centres (MTC) State labs (SL)
1.Govt. Doon Medical College, Dehradun 1.Govt. Doon Medical College, Dehradun
2.AIIMS Rishikesh, Dehradun 2.AIIMS Rishikesh, Dehradun
3.Govt. Medical College, Haldwani, Nainital 3.Govt. Medical College, Haldwani, Nainital
The overall implementation of program, coordination and monitoring & supervision will be conducted by State Viral Hepatitis Monitoring Unit (SVMHU). Below that at each district level, District Viral Hepatitis Monitoring Unit (DVMHU) will be established. All district hospitals will have a treatment centre and a diagnostic centre. Down the line screening of viral hepatitis patients will be conducted at CHC, PHC, Sub-centre/Health & wellness centre.
The model of Viral Hepatitis Control Program is as below
U.1 Service Delivery- Facility based:
Under National Viral Hepatitis Control program (NVHCP), Treatment centre to be established at District hospital in each district.
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Under Service Delivery- Facility based, there is total Rs. 0.10 Lakh approved per district treatment centre. @Rs. 5000 per year approved for Meeting Costs/Office expenses/Contingency and @Rs. 5000 per year for Management of Hep A & E cases
Amount approved Unit Physical in FY FMR code Budget Head Remarks Cost Target 2020-21 (Rs. In Lakh)
U.1 Service 0.10 Delivery- 1.3.1.18 FacilityTreatment based Centres Meeting Rs. Budget approved @Rs. 1.3.1.18.1 Costs/Office 5000 1 0.05 5000 per year/District for expenses/Contin per Treatment Centre (District gency year Hospital) Rs. Budget approved @Rs. 1.3.1.18.2 Management of 5000 5000 per year/District for 1 0.05 Hep A & E per Treatment Centre (District year Hospital)
Service Delivery- U.2 Community ------based
Community U.3 ------Interventions
U.4 Untied Fund ------
U.5 Infrastructure ------
U.6 Procurement
Under Procurement, Rs. 28154 approved for Consumables for treatment centre at District Hospital (plasticware, RUP, evacuated vacuum tubes, waste disposal bags etc)
Amount approved Unit Physical in FY FMR code Budget Head Remarks Cost Target 2020-21 (Rs. In Lakh)
U.6 Procurement 0.28
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Budget approved for Consumables for Consumables for treatment sites treatment centre at (plasticware, RUP, Rs. District Hospital 6.2.23.4 1 0.28 evacuated vacuum 28154 (plasticware, RUP, tubes, waste evacuated vacuum disposal bags etc) tubes, waste disposal bags etc)
U.7 Referral Transport ------
Service Delivery- U.8 ------Human Resource
Training and U.9 ------Capacity building
Review, Research, U.10 Surveillance and ------Surveys
Budgeted in IEC/BCC U.11 IEC/BCC ------Annexure
U. 12 Printing
Under Printing activities, in FMR code 12.17.4 Budget approved @ Rs. 0.10 lakh for Printing for formats/registers etc. under NVHCP.
FMR Budget Head Unit Physic Amount approved Remarks Code Cost al in FY 2020-21 (Rs. Target In Lakh)
U.12 Printing 0.10
12.17 Printing for Rs. 1 0.10 Budget approved Rs. .4 formats/registers 1000 0.10 lakh for Printing for under NVHCP 0 formats/registers etc. under NVHCP. U.13 Quality ------Assurance
U.14 Drugware Housing and Logistics
Under Drugware Housing and Logistics, Rs. 7000 approved for Sample transportation cost under NVHCP.
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Budget Head Amount Physi approved FMR Unit cal in FY Remarks Code Cost Target 2020-21 (Rs. In Lakh) U.14 Drugware Housing and 0.07 Logistics
14.2.1 Sample transportation cost Rs. Budget approved for 1 0.07 3 under NVHCP 7000 Sample transportation cost under NVHCP U.15 PPP ------U.16 Programme Management ------
IT initiatives for U.17 ------strengthening Service Delivery U.18 Innovations (If any) ------
Note :
Budget for Human Resource is available in separate chapter for FMR 8 and 16 Budget for Human Resource IEC is available in separate chapter for FMR 11
Summary of approvals FY 2020-21 NHM_NVHCP_ Tehri
Amount approved in FY 2020- FMR Budget Head 21 (Rs. In Lakh)
U.1 Service Delivery- Facility based 0.10
U.6 Procurement 0.28
U.11 IEC/BCC Budgeted in IEC/BCC Annexure
U.12 Printing 0.10
U.14 Drugware Housing and Logistics 0.07
Total 0.55
Note :
Budget for Human Resource is available in separate chapter for FMR 8 and 16 Budget for Human Resource IEC is available in separate chapter for FMR 11
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Chapter -21 National Programme for Climate Change and Human Health
Climate change is defined as “a change of climate which is attributed directly or indirectly to human activity that alters the composition of the global atmosphere and which is in addition to natural climate variability observed over comparable time periods.” It affects social and environmental determinants of health like –clean air, safe drinking water, sufficient food and secure shelter.
Climate change may negatively affect human health through a number of ways, but the commonly experienced are increased frequency and intensity of heat waves leading to rise in heat related illnesses and deaths, increased precipitation, floods, droughts and desertification costing lives directly. High temperature is known to increase the level of ‘ground level ozone’ and other ‘climate altering pollutants’ other than carbon dioxide, which further exacerbate cardio- respiratory and allergic diseases and certain cancers. Beside these, there is increase in transmission and spread of infectious diseases, changes in the distribution of water-borne, food borne and vector-borne diseases and effects on the risk of disasters and malnutrition.
National Centre for Diseases Control (NCDC) is identified as the ‘technical nodal agency’ by MoHFW for Climate Change and Human Health. Further, to strengthen and support activities at the states, the National Programme on Climate Change and Human Health has been included under the National Health Mission. Goal:
To reduce morbidity, mortality, injuries and health vulnerability due to climate variability and extreme weathers
Objective: To strengthen health care services against adverse impact of climate change on health.
Specific Objectives
Objective 1: To create awareness among general population (vulnerable community), health-care providers and Policy makers regarding impacts of climate change on human health.
Objective 2:
To strengthen capacity of healthcare system to reduce illnesses/ diseases due to variability in climate.
Objective 3: To strengthen health preparedness and response by performing situational analysis at state/ district/ below district levels.
Objective 4: To develop partnerships and create synchrony/ synergy with other missions and ensure that health is adequately represented in the climate change agenda in the state in coordination with the Ministry of Health & Family Welfare.
Objective 5: To strengthen state research capacity to fill the evidence gap on climate change impact on human health
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U.9 Training and capacity building
Under Training and capacity building, Rs. 1.19 Lakh is approved :
1. Budget of Rs. 0.45 Lakh approved for 1 day Training of Medical Officers for 1 batch under NPCCHH and State Specific Climate Sensitive Health issue (1 Batch- 25 Participants)
2. Budget of Rs. 0.74 Lakh approved for 1 day Training of Paramedical staff for 2 batches on State Specific Climate Sensitive Health issue @ Rs. 37000 per Batch (1 Batch- 25 Participants) Amount approved in Physical FMR Budget Head Unit Cost FY 2020-21 Remarks Target (Rs. In Lakh)
U.9 Training and 1.19 capacity building
9.5.29.8 Trainings of Medical Rs. 3 1.19 Officers, Health 39666 batches 1. Budget of Rs. 0.45 Workers and Lakh approved for 1 Programme officers day Training of under NPCCHH Medical Officers for 1 batch under NPCCHH and State Specific Climate Sensitive Health issue (1 Batch- 25 Participants)
2. Budget of Rs. 0.74 Lakh approved for 1 day Training of Paramedical staff for 2 batches on State Specific Climate Sensitive Health issue @ Rs. 37000 per Batch (1 Batch- 25 Participants)
U.10 Review, Research, ------Surveillance and Surveys
U.11 IEC/BCC ------Budgeted in IEC/BCC Annexure
U.12 Printing
Under Printing, Rs. 0.10 Lakh is approved for Printing activities under NPCCHH and State Specifc Climate Sensitive Health issue i.e. training materials, reporting formats, guidelines etc.
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Amount Physic Unit approved in Budget Head al Remarks FMR Cost FY 2020-21 Target (Rs. In Lakh)
U.12 Printing 0.10
Budget of Rs. 0.10 Lakh approved for Printing activities under NPCCHH Printing Rs. and State Specifc Climate 12.17.3 activities for 1 0.10 10000 Sensitive Health issue i.e. NPCCHH training materials, reporting formats, guidelines etc.
Quality U.13 ------Assurance
Drugware U.14 Housing and ------Logistics
U.15 PPP ------
U. 16 Programme Management
Under Programme Management, Rs. 0.20 lakh approved for One day Task force meeting with invited experts from health and non-health sectors to develop health sector plans for Heat and Air Pollution for 2 meetings @ Rs. 10000 Per Meeting.
FMR Budget Head Unit Cost Physical Amount Remarks Target approved in FY 2020-21 (Rs. In Lakh)
U.16 Programme 0.20 Management
16.1.2.1.23 Task force Meeting Rs. 10000 2 0.20 One day Task force to draft health per meeting with invited sector plan for meeting experts from health and Heat and Air non-health sectors to Pollution develop health sector plans for Heat and Air Pollution. Budget of Rs. 0.20 lakh for 2 meetings @ Rs. 10000 Per Meeting
U.17 IT initiatives for ------strengthening
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Service Delivery
U.18 Innovations (If ------any)
Note :
Budget for IEC is available in separate chapter for FMR 11
Summary of approvals FY 2020-21 NHM_NPCCHH_Tehri Garhwal
Amount approved in FY 2020-21 FMR Budget Head (Rs. In Lakh)
U.9 Training and Capacity building 1.19
Budgeted in IEC/BCC U.11 IEC/BCC Annexure
U.12 Printing 0.10
U.16 Programme Management 0.20
Total 1.49
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Chapter -22 National Rabies Control Program
Rabies is almost 100% fatal zoonotic disease transmitted from animals and is responsible for considerable mortality of humans in lndia. To address this issue, National Rabies Control Programme (NRCP) is being implemented in lndia. National Centre for Disease Control (NCDC) is the nodal agency for implementing the programme.
The programme activities include training of health care professionals about appropriate animal bite management and Rabies Prophylaxis, surveillance of animal bites and human Rabies cases, IEC activities for generating community awareness and strengthening diagnosis of rabies in humans.
Objectives:
1. Training of Health Care professionals on appropriate Animal bite management and Rabies Post Exposure Prophylaxis. 2. Adopt and implement Intradermal route of Post exposure prophylaxis for Animal bite Victims and Pre exposure prophylaxis for high risk categories. 3. Strengthen Human Rabies Surveillance System. 4. Creating awareness in the community through Advocacy & Communication and Social Mobilization. 5. Ensure availability of ARV and ARS.
U.6 Procurement
Under Procurement, Rs. 0.60 Lakh is approved for Procurement of Computer and Printer for Model Anti Rabies Clinic. Model Anti Rabies Clinic to be made functional at District Hospital as per GOI guidelines.
Amount Unit Physical approved in FMR Code Budget Head Remarks Cost Target FY 2020-21 (Rs. In Lakh)
U.6 Procurement 0.60
Procurement of Rs. 0.60 Lakh is equipment & approved for computer for district Procurement of Rs. 6.1.2.6.2 level Model Anti 1 0.60 Computer and Printer 60000 Rabies Clinics in for Model Anti existing health Rabies Clinic at facilities District Hospital
U.7 Referral Transport ------
Service Delivery- U.8 ------Human Resource
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U.9 Training and capacity building
Under Training and capacity building, Rs. 0.45 Lakh is approved for 1 day training at district level on Rabies diagnosis and management under National Rabies Control Programme for Medical Officers and Health workers for 1 Batch @ Rs 45000/- per batch (1 Batch- 25 participants).
FMR Budget Head Unit Cost Physical Amount Remarks Target approved in FY 2020- 21 (Rs. In Lakh) U.9 Training and 0.45 capacity building
9.5.29.7 Trainings of Medical Rs. 1 batche 0.45 Budget of Rs. 0.45 Lakh Officers and Health 45000 is approved for 1 day Workers under training at district level NRCP on Rabies diagnosis and management under National Rabies Control Programme for Medical Officers and Health workers for 1 Batch @ Rs 45000/- per batch (1 Batch- 25 participants).
U.10 Review, Research, ------Surveillance and Surveys
U.11 IEC/BCC ------Budgeted in IEC/BCC Annexure
U.12 Printing
Under Printing, Rs. 0.15 Lakh is approved for printing of reporting formats, guidelines etc. for monitoring and surveillance under NRCP.
Amount Unit Physica approved in FY Budget Head Remarks FMR Cost l Target 2020-21 (Rs. In Lakh)
U.12 Printing 0.15
Budget of Rs. 0.15 Lakh approved for printing of Printing of formats for Rs. 12.17. reporting formats, Monitoring and 1500 1 0.15 2 guidelines etc. for Surveillance 0 monitoring and surveillance under NRCP
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U.13 Quality Assurance ------
Drugware Housing U.14 ------and Logistics
U.15 PPP ------
U. 16 Programme Management
Under Programme Management, Rs. 0.10 lakh approved for review meetings and Travel/Mobility Support etc. under NRCP.
FMR Budget Head Unit Cost Physical Amount Remarks Target approved in FY 2020- 21 (Rs. In Lakh) U.16 Programme 0.10 Management 16.1.2.2.16 Monitoring and Rs. 1 0.10 Budget of Rs. 0.10 Surveillance (review 10000 lakh approved for meetings , Travel) review meetings under NRCP and Travel/Mobility Support etc. under NRCP
U.17 IT initiatives for ------strengthening Service Delivery
U.18 Innovations (If any) ------
Note : Budget for IEC is available in separate chapter for FMR 11
Summary of approvals FY 2020-21 NHM_NRCP_ Tehri Garhwal
Amount approved in FY 2020-21 FMR Budget Head (Rs. In Lakh)
U.6 Procurement 0.60
U.9 Training and Capacity building 0.45
U.11 IEC/BCC Budgeted in IEC/BCC Annexure
U.12 Printing 0.15
U.16 Programme Management 0.10
Total 1.30
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Chapter -23 National Leprosy Eradication Program (NLEP)
Introduction:
Leprosy is a chronic infectious disease with long incubation period. Since the National Leprosy Eradication Programme aims to eradicate the disease i.e. nil case of leprosy as the ultimate goal, sustain control measures need to continue during 2020-21 and in future also.
Objectives:
a. Elimination of Leprosy i.e. PR below 1 per 10000 population in all districts. b. Annual New Case Detection Rate below 10 per lac population in all districts. c. Treatment Completion Rate of leprosy – In MB cases more than 95%
In PB cases more than 97%
d. Strengthen Disability Prevention & Medical Rehabilitation of persons affected by leprosy. e. Reduction in the level of stigma associated with leprosy.
New Initiatives: In order to achieve Leprosy Eradication Goals in Uttarkhand State below listed new activities needs to be made operational in the districts.
1. Focused Leprosy Campaign: Under this activity intensive case search will be conducted around Gr.II disability cases considering them as hot spot for strengthening Leprosy Surveillance .
2. ASHA Based Surveillance for Leprosy Suspects (ABSULS): Is an ongoing activity needs to strengthened in all the District of Uttarakhand State.
3. Post Exposure Propylaxis (PEP): WHO has recently released guidelines for diagnosis, treatment & prevention of Leprosy, Wherein, Post Exposure Prophylaxis has been recommended. Accordingly, it has been decided to Launch Post Exposure Prophylaxis nationwide for all contacts of Leprosy cases detected with effect from 2nd October 2018. Contacts of all existing cases as on date and future cases, may need to be given single dose rifampicin (SDR) Prophylaxis as part of NLEP.
1. Service Delivery- Facility based : 1. Service Delivery- Facility based : Case Detection & Management : Specific Plan for high Endemic Districts: In ROP 2020-21 As per GOI remarks, Active Case Detection has to be done throughout the state round the year on regular basis and not in campaign mode (LCDC) or only for endemic Districts. Guidelines to conduct the Active case detection activity will be shared with Districts later as soon as received from Central Leprosy Division.
Case Detection & Management : Services in Urban Areas: In Uttarakhand State 3 cities i.e. Dehradun, Haridwar & U.S. Nagar are identified by Govt. for Urban Leprosy Control Programme. The following is required for ULCP units as per GOI guidelines – 1- Supportive Medicine – Rs. 9000 each for 3 cities 2- MDT delivery & follow up – Rs. 5000 each for 3 cities.
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3- Monitoring, Supervision & Coordination which include periodic meeting & mobility – Rs. 10000 per city.
Support to Govt. Institutions for Conducting RCS : Support to Govt. Institution for conducting 2 days RCS Camp @ Rs. 5000/Patient as per GOI Guidelines. Welfare Allowance for RCS : Welfare allowance for RCS Patients @ Rs. 8000/RCS eligible Case as per GOI Guidelines
New Old Budget Head Unit Qnty Amount Remark FMR FMR cost Approved Code Code Rs. In Lakh 1 Service 0.072 Delivery- Facility based G.1.1 Case Detection 0.072 For Conducting active & Management case detection : Specific Plan throughout the district 1.1.5.4 for high round the year. endemic Guidelines for the Districts above activity will be shared later with Districts as soon as it will be received from GOI. 1.1.5.5 G.1.2 Case Detection 0.00 0 0.00 & Management : Services in Urban Areas 1.1.5.6 G.2.4 Support to 0.00 0 0.00 Govt. institutions for RCS 1.2.3.1 G.2.3 Welfare 0.00 0 0.00 allowance to patients for RCS
2. Service Delivery- Community based DPMR at Camps: To Conduct 2 days RCS Camp for TA/DA, boarding, lodging to surgeons visiting for the purpose, Lunch etc. to the camp participants.
New Old Budget Head Unit cost Qnty Amount Remark FMR FMR Approved Code Code Rs. In Lakh Service Delivery- 2 0.00 Community based
DPMR: at 2.3.2.2 G.2.5 0.00 0 0.00 Camps
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3. Community Interventions
ASHA involvement under NLEP: Accredited Social Health Activists (ASHA) involvement in NLEP to bring out suspected cases from their villages/Areas for diagnosis at PHC and after confirmation of diagnosis, will follow up the patients for completion of treatment. The ASHA will be entitled to receive incentive as below: (i) At confirmation of diagnosis – Rs. 250/- (ii) For Late Detection of new case with visible deformity in hands, feet or eye – Rs. 200/- (ii) On completion of full course of treatment in time – PB - additional Rs.400/ MB - additional Rs.600/- ASHA Sensitization: NLEP 1 Day training for Sensitization of ASHA @Rs.100/ASHA.
Activities to be performed by ASHAs: (i) Search for suspected cases of leprosy i.e. before any sign of disability appears. Such early detection will help in prevention of disability and also cut down transmission potential.
(ii) Follow up all cases for completion of treatment in scheduled time. During follow up visit also look for symptoms of any reaction due to leprosy and refer them to the Health Workers/PHC for treatment. This will again reduce chances of disability occurring in cases under treatment.
(iii) Advise and motivate self-care practices by disabled cases for proper care of their hands and feet during the follow up period. This will improve quality of life of the affected persons and prevent deterioration of disabilities.
(iv) Spreading awareness.
New FMR Old FMR Budget Head Unit cost Qnty Amount Remark Code Code Approved Rs. In Lakh Community 3 0.03 Interventions ASHA Involvement 3.1.1.4.8 G.1.3.a 0.03 under NLEP - Sensitization ASHA ASHA incentive for Incentive for Rs.250 for 4 detection of 4 3.1.1.4.8.1 G.1.3.b.i 0.01 detection of Detection Cases Leprosy Leprosy Cases @ Rs. 250/Case ASHA incentive for ASHA Rs.400 for PB Treatment Incentive for 3.1.1.4.8.2 G.1.3.b.ii Treatment 2 Case 0.008 completion of PB (Treatment Completion 2 PB Leprosy Completion) Cases @ Rs. 400/Case AHSA ASHA Rs.600 for incentive for Incentive for MB 3.1.1.4.8.3 G.1.3.b.iii 2 Case 0.012 Treatment MB (Treatment Treatment completion of Completion) Completion of 2 MB
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Leprosy Case @ Rs. 600/Case
Any other 3.1.1.4.9 (ASHA 0 0 0.00 Sensitization)
4. Untied Fund -NIL
U.5. Infrastructure -NIL
6. Procurment: Lab Reagents: Procurement of equipment for lab reagents. MCR Footwear: Procurement of MCR Footwear for the needy PALs with insensitive feet residing in Kushth Ashrams and their own houses @ Rs. 400/Pair. Aids & Appliances : Aids and appliances (Crèches, goggles, hand grip etc) for Medical Rehabilitation are supplied to the Leprosy Patients. Supportive Drugs: Procurement of Supportive Drugs for Leprosy Patients.
New FMR Old Budget Head Unit cost Qnty Amount Remark Code FMR Approved Code Rs. In Lakh
Procurement: 1.82 6 For Procurement of procurement of bio-medical 1 bio-medical Equipment: 5,000 0.05 District equipment: NLEP (Lab NLEP (Lab Reagents) 6.1.1.17.1 G.1.4 Reagents) Procurement of 160 pairs of 160/ MCR Footwear MCR 400/pair 0.64 Pairs @ Rs. 400/MCR 6.1.2.3.1 G.2.1 footwear Aids & Appliances i,e, Goggles, 1 Aids/Appliances 15,000 0.15 Crutches, District Sunglasses, Handgrip, self 6.1.2.3.2 G.2.2 care kits, etc. Rs. Procurement of Supportive 98,000 for 1 0.98 Supportive Drugs Supportive District Drugs 6.2.13.1 G.1.4 Medicines
7. Referral Transport -NIL
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8. Service Delivery- Human Resource: Para Medical Worker under NLEP: 3 PMW under NLEP i.e 1 PMW at District Haridwar and 2 PMW at District Udham Singh. New FMR Old FMR Budget Unit cost Qnty Amount Remark Code Code Head Approved Rs. In Lakh Service Delivery- 8 0.00 Human Resource: 8.1.1.12 B.30.1.11 PMW NLEP 0 0 0.00
9. Training and Capacity building: Capacity Building Under NLEP: Three Days NLEP training will be provided to 100 newly appointed in two Batches I.e, Garhwal & Kumaun Region. New FMR Old FMR Budget Unit cost Qnty Amount Remark Code Code Head Approved Rs. In Lakh
Training and 0.00 Capacity 9 building: Capacity Building 0.00 0 0.00 under NLEP 9.5.13.1 G.3.1 Any other (Please 0.00 0 0.00 specify) 9.5.13.2 10. Review, Research, Surveillance and Surveys
New FMR Old FMR Budget Unit cost Qnty Amount Remark Code Code Head Approved Rs. In Lakh 10.5 Sub- 2.00 national Disease Free Certification 10.5.2 Leprosy 2,00,000 1 2.00 As per GOI District remarks Activity approved subject to the condition that certification shall be done only after external evaluation and validation as per guidelines.
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11. IEC/BCC: The IEC Activities will focus on communication for behavioral changes in the general public. Changes are required because:
Stigma associated with the disease and discrimination against the leprosy affected persons are still perceived. The effective way to deal with this difficult challenge of stigma removal is to embark on intensive Inter-Personal Communication (IPC) with the target groups.
Certain level of awareness has developed in the communities due to the persistent efforts in communication during last decade. However, continuous efforts are needed to cover the uncovered areas. Coverage will have to move from high risk centric to general community at large. Involvement of people affected by leprosy will also help in improving awareness, case detection and stigma reduction.
Objectives of IEC
To develop communication material vis-à-vis the target audiences and deliver effectively.
To complement and support the detection and treatment services being provided free of cost through the General Health Care System.
To remove stigma associated with leprosy and prevent discrimination against leprosy affected persons.
To specifically cover beneficiaries, health providers, influencers and the masses.
Activities to be conducted in IEC
Mass Media – TV, Radio and press in local languages.
Outdoor Media - Hoardings, Bus panels, Wall paintings, posters, leaflets, Rallies including Banners.
Rural Media - IPC meetings, School talks/quiz, Folk media, Exhibitions and Health Melas.
Advocacy - Meetings with Zila Parishad, Mahila Mandals, NGOs etc.
New FMR Old FMR Budget Unit cost Qnty Amount Remark Code Code Head Approved Rs. In Lakh
11 IEC/BCC: 1.25 IEC/BCC: IEC/BCC under Mass Media, NLEP to conduct Outdoor intensive IEC for media, Rural 11.16.1 B.10.6.10 1,25,000 1 1.25 stigma reduction media, associated with Advocacy leprosy as per Media for guidelines NLEP
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12. Printing: Printing of NLEP Forms & Formats, NLEP Case Registers, etc.
New FMR Old Budget Head Unit cost Qnty Amount Remark Code FMR Approved Code Rs. In Lakh
12 Printing: 0.0
Printing 12.1.2.1 G.1.4 0.00 0 0.00 Works
13. Quality Assurance -NIL
14. Drugware Housing and Logistics -NIL
15. PPP -NIL
16. Programme Management:
New FMR Old Budget Head Unit Qnty Amount Remark Code FMR cost Approved Code Rs. In Lakh 16 Programme 1.31 Management: Mobility Support Field 0.81 Visits 16.1.3.3.10 G.4.1.b Travel Expenses Contractual 0 0 0.00 staff at District level 16.1.3.3.11 Approved in vehicle hiring & POL Mobility Maintenance for Support : 40,000 1 0.40 effective supervision & District Cell Monitoring by DLO/DN G.4.5.b team. 16.1.3.5.1 G.5 Others: Travel Expenses for 41,000 1 0.41 Travel Expenses for regular Staff regular Staff Operational Cost (expenses on account of consumables, operating 0.50 expenses, office expenses, admin expenses,
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contigencies, transport of samples, miscellaneous etc.) 16.1.4.2.4 Office Operation & 25,000 1 0.25 Maintenance - Office Operation & G.4.3.b District cell Maintenance 16.1.4.2.5 District Cell- 25,000 1 0.25 Consumables District G.4.4.b Consumables Cell
17. IT Initiatives for strengthening service Delivery -NIL
18. Innovations (If Any) -NIL
Summary of Approval 2020-21 – NLEP : TEHRI GARHWAL
FMR Code Budget Head Total Approved (INR)
1. Service Delivery - Facility Based 0.072 3. Community Interventions 0.03 6. Procurement 1.82 10. Review, Research, Surveillance & 2.00 Surveys 11. IEC/BCC 1.25 16. Programme Management 1.31 Total 6.482
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Chapter -24 Revised National Tuberculosis Control Program (RNTCP)
Vision:- TB Elimination in Uttarakhand by 2024.
Goal- In Uttarakhand the estimated total TB Cases are 275/Lac per year in 2020 including both public and private sector with target of 32,000 for year 2020 for which to achieve universal access to quality TB diagnosis & treatment in the community.
Objectives-
• To achieve 90% TB Notification of all TB cases • To achieve 90% success rate for all New cases and 85% for all Re-treatment cases • To significantly improve the successful outcomes of treatment of DR-TB cases • To achieve decreased morbidity and mortality of HIV-associated TB • To improve outcomes of TB-care in private sector
Achievement so far-
1) In Uttarakhand Program has introduced daily regimen for treatment of drug sensitive TB in the year 2017, October month. 2) State has CBNAAT machines in all 13 District Headquarters& a mobile CBNAAT Van for U- DST and diagnosing TB patients amongst key populations. 3) Newer anti TB drug Bedaquiline has also been administered to two TB patient since 1 st September 2018.
1. Service Delivery Facility Based–RNTCP is providing facility based diagnostic and treatment services to TB patients through its DTCs, TUs and DMCs. Operational funds are required for dispensing the services and maintenance of office equipments in all these facilities.
New Old Budget Head Unit Qty Amount Remarks FMR FMR cost Approved Code Code Rs. In Lakh 1 Service Delivery Facility Based Diagnosis and 1.1.5.7 Management under Budget released Latent TB Infection for testing of Management latent TB infection by IGRA and TST 1.25 Test in Kidney failure, Organ transplant and Silicosis patients.
1.2.3.2 H.3.5 TB Patient Nutritional Support under Nikshay 36.72 Poshan Yojana
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NPY for TB patients notified from public sector 25.56
NPY for TB patients notified from private 7.56 sector NPY for Drug Resistant TB patients 3.60 1.3.1.12 H.5 Maintenance of Office 0.59 Equipment
3. Community Interventions- The honorarium/counseling charges for provision of DOT will be paid only to such workers who are not salaried employees of the Central/State Government. This would include among others Anganwadi workers, trained dais, village health guides, community volunteers, ASHA, etc. The honorarium/ counseling charges to be paid to volunteer supervising MDR‐TB treatment.
New Old Budget Head Unit Qty Amount Remarks FMR FMR cost Approved Code Code Rs. In Lakh 3 Community Interventions 3.2.3.1 H.3 Honorarium under RNTCP 10.00
3.2.3.1.1 Treatment Supporter Rs 6 lakh will be paid to Honorarium (Rs 6.00 treatment supporter against 1000) 600 patient @Rs 1000/patient
3.2.3.1.2 Treatment Rs 3 lakh will be paid to Supporter treatment supporter of DR-TB Honorarium (Rs 3.00 patient against 60 patient 5000) @Rs 5000/patient
3.2.3.1.3 Incentive for Rs 1 lakhs will be paid as informant (Rs Informant incentive for 200 1.00 500) patient @ 500/patient.
3.2.6 Community Engagement under RNTCP
3.2.6.1 State/District TB 0.20 To organize District TB Forums Forum-Biannually
3.2.6.2 Community engagement 0.0 activities
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4. Untied Fund – NIL
5. Infrastructure- For civil work, plumbing, electrical and other repairs for facilities/ structures under RNTCP like STC, STDC, SDS, IRL, C&DST lab, DRTB Centre, DTC, DDS, TU, DMC etc. The maintenance amount for DMCs and TUs may be pooled at district level and repairs are undertaken where necessary.
New FMR Old Budget Head Unit Qty Amount Remarks Code FMR cost Approved Code Rs. In Lakh 5 Infrastructure 5.3.14 H.1 Civil Works under - - 0 RNTCP
6. Procurement
Procurement of Equipment- Lab Equipment: Binocular Microscopes & Fluorescent LED based microscope are being provided by CTD for training institution and for service delivery in RNTCP areas.
• Office Equipment: Office equipment will be procured by States/districts for new units planned under the project (State TB cell, DTC, SDS, IRL and DRTB Centre) and for replacing them which are more than 5-7 years old and are not functional.
Equipment Maintenance- Maintenance/upgradation costs for Laboratory equipment and office equipment like computers, photocopier, fax, etc. are included under this head.
Laboratory Materials- Lab consumables for DMCs, Culture / DST laboratories, STDCs, NRLs and IRLs to be procured.
Procurement of Drugs- Drugs required during TB treatment are being procured centrally. They are not to be procured at the State and Districts levels except with written approval from CTD.
New FMR Old Budget Head Unit Qty Amount Remarks Code FMR cost Approved Code Rs. In Lakh 6 Procurement 6.1.1.18.1 H.17 Procurement of 1.82 Equipment Other Lab Equipment 1.30 Procurement of (Specify) Binocular Microscope
Lab Equipment 0.52 Others
Equipment Maintenance 6.1.3.1.3 H.5 Equipment 1.02 Maintenance Lab Equipment 0.57
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Binocular Microscopes 0.32
LED Fluorescent Microscope 0.13
6.2.14.1 H.2 Laboratory Materials 2.08 Lab consumables for ZN/LED Microscopy 6.2.14.2 H.15 Procurement of Drugs 2.37 Procurement of first & second line drugs 6.2.14.3 Any other drugs & 2.30 For specimen collection supplies (please and transportation cost specify) for DMCs to CBNAAT sites and DMCs to IRL 6.5.2 H.11 Procurement of sleeves and drug 2.04 boxes
Procurement of Drug Procurement of DR-TB Boxes 1.14 patient month wise boxes Procurement of 99 DOTS Sleeves 0.90
6.5.3 Any other (please Procurement of specify) 2.46 specimen packaging material
7- Referral Transport (Previously known as patient support)
Tribal/Hilly/Difficult areas : Patients from tribal / hilly/ difficult areas to be provided an aggregate amount of Rs. 250 on completion of treatment to cover travel costs of patient and attendant. MDR TB suspect travel to DTC / Collection centre to be paid as per the actual with public transport. MDR /XDR TB patient travelling to DRTB Centre or to district for treatment initiation /follow-ups / adverse reaction management during the treatment along with one accompanying person / attendant. Travel cost to be reimbursed as per actual maximum upto equivalent to travel cost with public transport or norms approved by society for such visits to be provided.
New FMR Old Budget Head Unit Qnty Amount Remarks Code FMR cost Approved Code Rs. In Lakh Referral Transport Not Approved 0 . Patient Support & 7.5 H.18 Transportation Charges
0 Tribal Patient Support and 7.5.1 H.18.1 transportation charges
0 7.5.2 Any Other (please specify)
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8. Service Delivery- Human Resource
New FMR Old FMR Budget Head Unit Qty Amount Approved Remarks Code Code cost Rs. In Lakh
Service Delivery- Please refer to Human Resource HR annexure
9. Training
The training of STO/DTOs will be organized in coordination with central institutes / CTD. The other categories of staff will be trained at State/District/Sub-district level. It also includes sensitization. The training will be held in batches and cost for each batch of training for different category of staff iscalculated applying the various approved norms .
The costs include hiring of venue, organization charges, honorarium for trainers, TA/DA, course material and refreshment or for any activity related to training.
State level facilities includes State TB cell, STDC, SDS, IRL, C&DST lab, DRTB Centre for all the financial heads including training.
New Old Budget Head Unit Qty Amount Remarks FMR FMR cost Approved Code Code Rs. In Lakh 9.5.14 Training 9.5.14.1 H.6 Trainings under NTEP 0.71
H.10 CME (Medical Colleges) 0 9.5.14.2 9.5.14.3 Any other (please specify) 0
10. Review, Research, Surveillance & Surveys –
New FMR Old Budget Head Unit Qty Amount Remarks Code FMR cost Approved Code Rs. In Lakh 10 - Review, Research, - - 0 Surveillance & Surveys Research & Studies & 10.2.8 H.14 Consultancy Research for medical 0 10.2.9 H.10 colleges 0 Operational Research Sub-national Disease Free 10.5 Certification
10.5.1 Tuberculosis
District Level
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11. IEC/BCC
ACSM activities are design by the RNTCP for community mobilization for TB care and control. This includes various activities like patient provider meeting,community meeting, CME, activities in school / educational institutions, advocacy meetings, PRI involvement, involvement of FBOs, activities during World TB Day/ week and outdoor activities i.e.nukkadnataks, streetplays, wall painting etc.
New Old Budget Head Unit Qty Amount Remarks FMR FMR cost Approved Code Code Rs. In Lakh 11 IEC/BCC 11.17.1 H.4 ACSM 1.85 Fund are allocated for PPM meeting, community mobilization, School activities, Outdoor activity, CME, World TB Day, ACSM during ACF, ACSM activities during Active TB Case Finding. 11.17.2 TB Harega Desh 0.80 Jeetega' Campaign
12. Printing
Printing of stationery items such as treatment cards, patient identity card, TB register, laboratory form, referral form, notification form, health establishment registration form, transfer form, training modules, quarterly report format, research reports, Action Plans and other formats required for Programme implementation at State/District level.
New Old Budget Head Unit Qty Amount Remarks FMR FMR cost Approved Code Code Rs. In Lakh 12 Printing
12.13.1 H.4 Printing (ACSM) 0.52 12.13.2 H.13 Printing 0.86
13. Quality Assurance – NIL
14. Drug Warehousing and Logistics
Vehicle operation (POL & maintenance) Vehicles used for supervisory visits by DTO, MO‐TC and contractual staff under RNTCP are budgeted on the basis of:
• Kilometers traveled/day, number of days in a month and current cost of POL.
• Total amount includes repairs, spare parts, insurance, tax, helmets, PUC, essential accessories, service charges, etc. which may be required for the maintenance of vehicles.
Vehicles Hiring Vehicles are hired where RNTCP or State Government Vehicle are not available for supervisory visits. Appropriate documentation for supervisory visits to be ensured. MOTC/ Officer /Staff having NRHM hired vehicle available for supervision & monitoring, cannot
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State level officers & Coordinators can hire vehicle for the days of supervision & monitoring visits.
Old Qnty Amount Remarks New FMR Budget Head Unit Approved FMR Code cost Rs. In Code Lakh 14 Drug Warehousing and Logistics 14.2.12 H.11 Drug transportation charges 0.84 Transportation of drugs and
other logistics
15. PPP
Activities included in this head are payments of NGO/PP schemes grant-in-aid, activities undertaken for involvement of NGO/PPs, Cost of the state and district level PPM Coordinators and TBHVs, and costs for pilots / innovations for improving TB control at central / state / district / sub district level.
Unit Amount New Old Budget Head cost Qty Approved Remarks FMR FMR Rs. In Code Code Lakh 15.5 PPP under RNTCP 0 Public Private Mix (PP/NGO 15.5.1 H.9 0.00 Support) Any Public Private Mix 15.5.1.1 0 (PP/NGO Support) Public Private Support Agency 15.5.2 H.9.1 (PPSA) 15.5.3 H.9.2 Private Provider Incentive 0 Multi-sectoral collaboration 15.5.4 0 activities
16. Programme Management
Activities included in this head TA/DA reimbursement payments state & district RNTCP staff for supervision & monitoring visit.
New FMR Old Budget Head Unit Qty Amount Remarks Code FMR cost Approved Code Rs. In Lakh Human Resource - Given 16.40 separately Medical Colleges (Any 16.1.2.1.21 H.10 0.00 meetings)
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Supervision and 16.1.2.2.13 H.19 2.01 Monitoring
Vehicle Operation (POL & 16.1.3.1.13 H.7 3.81 Maintenance) 0.88 16.1.3.1.14 H.8 Vehicle hiring
Any other (Specify) Medical Colleges (All 16.1.3.3.12 H.10 service delivery to be budgeted under B.30) Office Operation 16.1.4.1.10 H.11 0.86 (Miscellaneous)
17. Innovation
New FMR Old Budget Head Unit Qty Amount Remarks Code FMR cost Approved Code Rs. In Lakh 18.10 Active TB Patients - 4.86 screening
Summary of Approvals 2020-21 ; NTEP, Tehri
FMR Code Budget Head Total Approved (INR In Lakhs ) U.1 Service Delivery - Facility Based 38.56 U.3 Community Interventions 10.20 U.6 Procurement 14.09 U.7 Referral Transport 0 U.8 Service Delivery - Human Resource 0 U.9 Training & Capacity Building 0.71 U.11 IEC/BCC 2.65 U.12 Printing 1.38 U.14 Drug Warehousing and Logistics 0.84 U.16 Programme Management 7.56 U.18 Innovations (if any) 4.86 Total 80.85
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Chapter -25 Non Communicable Disease Control Programs (NCD)
Programmes under NCD
National Program for Cancer, Diabetes, Cardiovascular Disease and Stroke (NPCDCS). National Tobacco Control Program (NTCP). National Program for Control of Blindness (NPCB). National Mental Health Program (NMHP). National Program for Health Care of Elderly (NPHCE). National Oral Health Program (NOHP). National Program for Prevention and Control of Deafness (NPPCD). National Program for Palliative Care (NPPC). Pradhan Mantri National Dialysis Program (PMNDP). National Iodine Deficiency Disorder Control Program (NIDDCP)
National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS)
An Intergrated program called National Programme for prevention and control of Cancer, Diabetes, Cardiovascular Diseases and Stroke was launched in 2010 by merging the National Cancer Programme with the pilot programme.
Objectives Health promotion through behaviour change Prevention and early detection of NCDs. Building capacity at various levels of health care facilities for prevention, early diagnosis, treatment and rehabilitation in respect of NCDs. Supporting development of database for NCDs through regular surveillance Monitoring risk factors, morbidity and mortality associated with NCDs.
The strategies being adopted under the programme are prevention through behaviour change, early diagnosis, treatment, capacity building of human behaviour and surveillance, monitoring & evaluation.
COPD Programme Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality across the globe. In India NCDs were estimated to have accounted for 61.8 % of all deaths . India contributes a significant and growing percentage of COPD mortality which is estimated to be amongst the highest in the world; i.e. more than 64.7 estimated age standardized death rate per 100,000 amongst both sexes. In Uttarakhand, COPD is the second leading cause of DALYs( Disability adjusted life year.) 2410 DALYs per 100000(“India: Health of the Nation’s States”) .
Objectives:
To identify patients with respiratory diseases(COPD and Asthma) in its initial stages To provide quality treatment to the patients To improve quality of life of the patients suffering from COPD & Asthma. To reduce the mortality and morbidity rate.
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To achieve the objectives stated above GOI has initiated a dedicated programme under NPCDCS.
In Uttarakhand, the programme will be launched in phase manner. In first phase, three districts have been selected for the purpose namely Dehradun, Haridwar and U S Nagar. Under this programme, Individuals of any age with any signs or symptoms of respiratory disease or persons suffering from COPD and Asthma or having risk factors like smoking, will be screened and monitored at Health and Wellness Centre with the help of Peak Flow Meter. Individuals in yellow and red zone (50-80% or 50 % less) of the peak flow meter will then be referred to higher centre for further evaluation management.
National STEMI Program
According to WHO, cardiovascular disease (CVD) is the leading cause of disability and Death globally. CVD accounts for approximately 18 Million deaths annually (31% of all global Death).85 % of CVD deaths are due to heart attacks and strokes. 75% of Deaths are in middle and low-income groups/country. Death rate of CVD in India is 272 per 1.0 lakh population, greater than global average. In Uttarakhand, 10.9% of total death 15-39 year’s age group is due to CVD. In age group 40-69 years, 28.2% of total death is due to CVD.
The Govt. of India has launched the STEMI Programme to reduce mortality and morbidity caused by cardiovascular diseases.
STEMI program in the State of Uttarakhand will be initiated in the state capital (Dehradun) as pilot project and on the basis of success and experiences gained; it will be initiated in other Districts..
Universal Screening For Common NCDs
Major objective of the program is early diagnosis and prevention of five Non Communicable Diseases (Hypertension, Diabetes, Oral, Breast & Cervix Cancer). ASHA will conduct household survey and fill the Health Cards of people above 30 years of age as per Community Based Assessment Checklist. On the basis of the CBAC form suspected people will be referred to higher centre for early diagnosis and treatment. ASHA will get incentive @ Rs 10/ per CBAC mobilizing for NCD Screening and Rs 50/biannual for follow up of confirmed cases.
At present, program is implemented in 43 blocks of 13 districts throughout the state.
In Financial year 2020-21, additional 23 blocks of 13 districts to be covered under the program.
Capacity Building-
In FY 2019-20,State TOT of Medical officers, ANM and ASHA/AF completed. Modular District Training of MO, ANM and ASHA completed in all selected blocks of the financial year 2019-20.
Service Delivery-
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Till now 242 MO, 330 MLHP, 988 ANM and 6491 ASHA trained in the program at district level. Following are the details of Hypertension and Diabetes screening data:- Hypertension:- Year Total number of Total number of Total number of Persons Screened Persons found Persons on Treatment Positive 2018-19 8298 1336 1005 2019-20 180657 27797 23442 188955 29133 24447
Diabetes:- Year Total number of Total number of Total number of Persons Screened Persons found Persons on Treatment Positive 2018-19 6378 908 694 2019-20 144533 19671 17231 150911 20579 17925
Service Delivery- Facility Based
Budget New Quantity/ Old FMR Unit Approved FMR Budget Head Physical Remarks Code Cost (Rs. In Code Target Lakh) U.1 Service Delivery- Facility Based 0.50 1.3.1.8 O.2.2.1.3/ District NCD Clinic: 5000 1 0.50 Budget of Rs. O1.1.3.1 Strengthening of 0 0.50 lakh is lab, Mobility , approved for Miscellaneous & Mobility, Contingencies Miscellaneous & Contingencies.
Procurement
Budget New Quantity/ Old FMR Unit Approved FMR Budget Head Physical Remarks Code Cost (Rs. In Code Target Lakh) U.6 Procurement 12.245 Procurement of any other 6.1.2.6 equipment
Budget is approved for the procurement of equipments for screening of NCDs @ Rs 4000 per SC and @ Rs 24000 per PHC. Total 21 SC (Pratapnagar) and 24 PHC are approved. Equipments to be procured are BP Apparatus, VIA Kit- Examination Lamp, Cusco’s Speculum, Autoclave & Torch,
OVE Kit- Mouth Mirror & LED torch. 6.1.2.6.1 B.18.2 Procurement for 45 6.60 Budget of Rs.
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Universal 6.60 lakh is Screening of approved NCDs
6.2.19.1 B.16.2.11.8. Drugs & supplies 5000 1 0.50 Approved Rs. a for District NCD 0 0.50 lakh for the Clinic procurement of drugs. Budget is approved for the procurement of consumables for screening of NCDs @ Rs 8500 per SC and @ Rs 14000 per PHC. Total 21 SC ( Pratapnagar) and 24 PHC are approved. Consumables for Glucose testing- Glucostrips & Glucometer, VIA testing- gloves, cotton swabs, distilled water, acetic acid and OVE- wooden sticks, gloves, cotton, gauze 6.2.19.6 B18.2 Drugs & supplies 45 5.145 Budget of Rs. for Universal 5.145 is Screening of approved. NCDs
Referral Transport
Budget New Quantity/ Old FMR Unit Approved FMR Budget Head Physical Remarks Code Cost (Rs. In Code Target Lakh) Transport of referred cases including home based 7.6 0.50 care Budget approved Rs 50000 7.6.1 O.2.1.6.6.i District NCD Clinic 50000 1 0.50 For referral services in the NCD Clinic.
Training & Capacity Building
Budget Old Quantity/ New FMR Unit Approved FMR Budget Head Physical Remarks Code Cost (Rs. In Code Target Lakh) U.9 Training & Capacity Building 0.10 9.5.19.2 O.2.3.2 District NCD Cell 10000 1 0.10 Approved Rs. 0.10 lakh for training of staff under NCD.
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IEC/BCC
Budget Old Quantity/ New FMR Unit Approved FMR Budget Head Physical Remarks Code Cost (Rs. In Code Target Lakh) U.11 IEC/BCC 2.40 11.22 O.2.3 IEC/BCC activities
under NPCDCS Budget approved @ Rs 40000 at District NCD Cell for Organising World Cancer Day(4 Feb), World Heart Day(29 Sept) World Diabetes Day (14 Nov) World Stroke Day ( 29 Octuber). 11.22.2 O.2.3.2 IEC/BCC for District 40000 - 0.40 Approved NCD Cell Rs.0.40 lakh for IEC Budget approved @ Rs 5000 for 14 SC (Chamba) and 26 PHC for IEC activities at Health and Wellness Centre.
5000 40 2.00 Approved Rs IEC/BCC activities 2.00 lakh for 11.22.3 for Universal IEC at District Screening of NCDs level.
Printing Budget New Old Quantity/ Unit Approved FMR FMR Budget Head Physical Remarks Cost (Rs. In Code Code Target Lakh) U.12 Printing 6.75 Budget is approved for printing of Health Cards and Training Modules for doctors, staff nurses, ANMs and ASHA workers @ Rs. 15000 per HWC. Total 21 HWCs (Pratapnagar) and 24 PHC of the districts are approved. 12.15.3 Printing activities for 15000 45 6.75 Total budget of Universal Screening Rs. 6.75 lakh of NCDs - printing of is approved. cards and modules
Programme Management Budget Old Quantity/ New FMR Unit Approved FMR Budget Head Physical Remarks Code Cost (Rs. In Code Target Lakh) U.16 Programme Management 1.00 16.1.3.3.1 16.3.3. District NCD Cell 50000 1 0.50 Budget of Rs. 6 16 (TA,DA, POL) 50,000/- is approved. NPCDCS 16.1.4.2.9 16.4.2. District NCD Cell 50000 1 0.50 Budget of Rs. 9 (Contingency) 50,000/- is approved.
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Summary of Approval: NPCDCS FMR Budget Head Total Approval (Rs. In Lakh)
U.1 Service Delivery- Facility Based 0.50 U.6 Procurement 12.245 U.7 Referral Transport 0.50 U.9 Training & Capacity Building 0.10 U.11 IEC/BCC 2.40 U.12 Printing 6.75 U.16 Programme Management 1.00 Total 23.495
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National Tobacco Control Programme (NTCP)
According to the Global Adults Tobacco Survey 2016-17 (GATS 2), 29.8% of men, 6.3% of women and 18.1% of all adults currently smoke tobacco in Uttarakhand. 21.2% of men, 3.4 % of women and 12.4 % of all adults currently use smokeless tobacco. 43.6% of men,9.3% of women and 26.5 % of all adults either smoke tobacco /or use smokeless tobacco. From GATS 1 to GATS 2 ,the prevalence of any tobacco use decreased significantly by 4.2 percentage points from 30.7% in GATS 1 to 26.5% in GATS 2. The prevalence of smokeless tobacco use has increased marginally. Bidi and Khaini are the two most commonly used tobacco products.
Goals and Objectives: The objectives of NTCP are as under: To build up capacity of the States / Districts to effectively implement the tobacco control initiatives; To train the health and social workers; To undertake appropriate IEC activities and mass awareness campaigns, including in schools, workplaces, etc.; To set up a regulatory mechanism to monitor/ implement the Tobacco Control Laws; To establish a system of tobacco product regulation. Provide facilities for treatment of tobacco dependence . To take necessary action, in co-ordination with other Ministries and stakeholders, to fulfil the obligations(s) under the WHO Framework convention on Tobacco Control.
Service Delivery
Implementation of the prohibition of Electronic Cigarette (production, manufacture, import, export, transport, sale, distribution, storage and advertisement) bill throughout the State. Declaration of 7200 Educational Institutes (Schools and Colleges) tobacco free according to revised Guidelines for Tobacco Free Educational Institutions.
Service Delivery- Community Based Budget Old Quantity/ New FMR Unit Approved FMR Budget Head Physical Remarks Code Cost (Rs. In Code Target Lakh) U.2 Service Delivery- Community Based 3.12 Under Tobacco Cessation Centre, counsellor will conduct two Focus Group Discussions per month with group of six to ten tobacco users, those are on pharmalogical treatment. These healthy discussion will motivate others users to quit tobacco successfully. 2.3.2.5 M.2.1.1 Tobacco Cessation 1000 26 0.26 Total budget of Centre (TCC): Rs. 26,000/- is Weekly FGD with the approved @ Rs. tobacco users Rs 1000 per FGD 2.3.3.4 M.1.2 NTCP Programme at School Level Awareness regarding programs to be conducted both in public and private schools to help youth and adolescents to acquire the knowledge, attitude and skills that are required to make informed choices
Tehri District RoP 2020-21 Page 139 and decisions and understand the consequences of tobacco use. To cover the youth population, tobacco free program in one college to be organized. It will empower students and youth to contribute to the creation of tobacco free environment in which they can learn and live. Budget Old Quantity/ New FMR Unit Approved FMR Budget Head Physical Remarks Code Cost (Rs. In Code Target Lakh) 2.3.3.4.1 M.1.2.1 Coverage of Public 3000 50 1.50 Approved @ Rs. School 3000 per school program for 50 school programs 2.3.3.4.2 M.1.2.2 Coverage of Pvt. 3000 40 1.20 Approved @ Rs. School 3000 per school program for 40 school programs. 2.3.3.4.5 M.1.2.5 Sensitization 8000 2 0.16 Approved Rs. campaign for college 8,000/- for two students Sensitization campaign for college students
Community Interventions Budget New Old Quantity/ Unit Approved FMR FMR Budget Head Physical Remarks Cost (Rs. In Code Code Target Lakh) U.3 Community Interventions 0.20 Under NTCP, training of various stakeholders is an important activity of DTCC. Implementation of COTPA Act in achieving its outcome at district level is significantly dependent on well functioning of gram, block and district level panchayats. DTCC Team will sensitize Panchayati Raj Institutions members and other stakeholders through workshop. 3.3.3.2 M.1.1.4 Training of PRI's 1000 2 0.20 Budget of Rs. representatives/ 0 10,000/- is Police personnel/ approved for one Teachers/ Transport sensitizing personnel/ NGO workshop of PRI/ personnel/ other other stake stakeholders holders.
Procurement Budget New Quantity/ Old FMR Unit Approved FMR Budget Head Physical Remarks Code Cost (Rs. In Code Target Lakh) U.6 Procurement 0.50 National Tobacco Control Program Under TCC, procurement of Nicotex Gum (2mg and 4 mg) for the pharmalogical treatment of the Tobacco user. 6.2.18.1 B.16.2.11.7 Procurement of 5000 1 0.50 Approved Rs.
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medicine & 0 0.50 lakh for the consumables for procurement of TCC under NTCP Nicotex Gum.
Training & Capacity Building Budget Old Quantity/ New FMR Unit Approved FMR Budget Head Physical Remarks Code Cost (Rs. In Code Target Lakh) U.9 Training & Capacity Building 0.20 Under NTCP, training and capacity building is an important activity of the Cell. DTCC, under its initiative, should organize training programmes for multiple-stakeholders in the district, which include Doctors, Nurses, Community Health Workers, ASHAs, Civil Society Organizations, NCC, NSSO, IMA, IDA, Teachers, officials from Enforcement Departments like Police, Food Authorities, Municipal officers etc. 9.5.18.1.a M.1.1.1 Orientation of 15000 1 0.15 Budget of Rs. Stakeholder 15000/- is organizations approved for one district level workshop. 9.5.18.1.b M.1.1.2 Training of Health 5000 1 0.05 Budget of Rs. Professionals 5000/- is approved for one district level workshop.
IEC/BCC Budget Quantity/ New FMR Old FMR Unit Approved Budget Head Physical Remarks Code Code Cost (Rs. In Target Lakh) U.11 IEC/BCC 4.53 National Tobacco Control Program For declaration of Tobacco free institutions budget of Rs 4.03 lakh is approved for 01Signage & 01 wall painting for 700 Schools and 06 College and Govt. Buildings and Rs. 50000/- for other IEC activities (Organising No Tobacco day)
11.21.1 B.10.6.14 IEC/SBCC for 1 1 4.53 Budget of NTCP Rs.4.53 /- for IEC activity.
Printing Budget New Quantity/ Old FMR Unit Approved FMR Budget Head Physical Remarks Code Cost (Rs. In Code Target Lakh)
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U.12 Printing - - 0.10 12.14.1 Printing of Challan 10000 1 0.10 Budget of Books under Rs. 10000/- NTCP is approved.
Programme Management Budget Quantity/ New FMR Old FMR Unit Approved Budget Head Physical Remarks Code Code Cost (Rs. In Target Lakh) U.16 Programme Management 0.48 16.1.4.1.11 16.4.1.11 Tobacco 10000 1 0.10 Budget of Cessation Centre Rs. 10,000/- (TCC): Office is approved. Expenses 16.1.3.3.15 M.1.4.3 District Tobacco 30000 1 0.30 Budget of Control Cell : Rs. 30,000/- Mobility Vehicle is approved. Two District Level Coordination Committee (DLCC) meetings to be organized chaired by the District Magistrate regarding the implementation of COTPA 2003 in the district and the roles and responsibilities of members for the same. District Nodal Officer should convene meetings of the committee to design the road map of the program. 16.1.5.3.11 16.7.3.10 District Level 2000 4 0.08 Approved Coordination Rs. 8000/- Committee for organizing 1 DLCC meeting per quarter @ Rs. 2000/- per meeting.
Summary of Approval: NTCP
FMR Budget Head Total Approval (Rs. In Lakh) U.2 Service Delivery- Community Based 3.12 U.3 Community Interventions 0.20 U.6 Procurement 0.50 U.9 Training & Capacity Building 0.20 U.11 IEC/BCC 4.53 U.12 Printing 0.10 U.16 Programme Management 0.48 Total 9.13
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National Programme for Control of Blindness and Visual Imapirement (NPCB& VI)
National Programe for Control of Blindness was initiated in 1976 as 100% centrally sponsored programme with the goal to reduce prevalence of blindness to 0.3% by 2020 by developing eye care infrastructure human resource, improving accessibility quality of eye care services. Main cause of blindness in children and young adults is refractive error and in + 50 adults cataract.
Objectives To reduce Backlog of blindness through identification & treatment of blind at Primary, Secondary & tertiary level. To provide high quality comprehensive eye care to the affected population. To expand coverage of eye care services to the underserved areas. To enhance community awareness on eye care and lay stress on preventive measures. . To develop institutional capacity for eye care services by providing support for equipment, consumable material and training personnel.
Service Delivery
Eye Bank established in Sushila Tiwari Government Medical College.
Human Resource Development (Training) Under NPCB program, Elimination of Trachoma in India has been initiated. State level TOT has been imparted to Eye surgeons in Financial Year 2019-20. District level training of medical officers, Paramedical Ophthalmic Assistant and ANM will be provided by the trained eye surgeons in this financial year (2020-2021).
Service Delivery- Community Based Budget Old Quantity/ New FMR Unit Approved FMR Budget Head Physical Remarks Code Cost (Rs. In Code Target Lakh) U.2 Service Delivery- Community Based 2.82 Under NPCB&VI, Paramedical Ophthalmic Assistant (PMOA) will conduct screening of school children for refractive errors and distribute spectacles free of cost. 2.3.3.2 I.1.3 Screening and free 350 500 1.75 Approved @ Rs. spectacles to school 350.00 per case children @ Rs.350/- for spectacles to per case school children.
Under NPCB & VI, to extend the area of coverage of eye care services, it has been approved to distribute free spectacles for near work to old persons above 45 years of age suffering from presbyopia @ Rs 350 per pair. 2.3.3.3 I.1.4 Screening and free 350 305 1.07 Approved @ Rs. spectacles for near 350.00 per case vision to Old Person for spectacles to (New component) school children @Rs.350/- per case
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Procurement
Budget New Quantity/ Old FMR Unit Approved FMR Budget Head Physical Remarks Code Cost (Rs. In Code Target Lakh) U.6 Procurement 3.00 Under NPCB & VI, financial assistance (recurring) @ Rs 1000/- (Rupees One thousand only) to the Govt/District Hospitals for Cataract Surgery. The DPM of NPCB&VI will assure to achieve the target of Government facilities.
6.2.15.1 B.16.2.11.4. Assistance for 1000 300 3.00 Approved @ Rs. a consumables/dru 1000/- per case gs/medicines to for cataract the Govt./District operation at Govt Hospital for Cat Hosp. sx etc.@ Rs.1000/- per case
Training & Capacity Building
Budget Old Quantity/ New FMR Unit Approved FMR Budget Head Physical Remarks Code Cost (Rs. In Code Target Lakh) U.9 Training & Capacity Building 1.74 Budget approved training of MO, PMOA and ANM for Trachoma Elimination Program under NPCB& VI. 9.5.15.1 I.1.6 Training of PMOA 63800 1 1.74 Approved Rs. under NPCB 1.74 lakh for training of Staff.
IEC/BCC
Budget Quantity/ New FMR Old FMR Unit Approved Budget Head Physical Remarks Code Code Cost (Rs. In Target Lakh) U.11 IEC/BCC 0.395 National Blindness Control Program Under NPCB&VI, budget is approved for organizing World Glaucoma week @ Rs 10000/-, World Sight day @ Rs 9500/- and Eye Donation fortnight @ Rs 20000/- at district level. 11.18.1 B.10.6.11 State level IEC @ 39500 1 0.395 Approved Rs. Rs.5 lakh for 39500/- Minor State.
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PPP Budget New Quantity/ Old FMR Unit Approved FMR Budget Head Physical Remarks Code Cost (Rs. In Code Target Lakh) U.15 PPP 30.00 National Blindness Control Program To reduce the backlog of blindness through identification and treatment of blind, secure participation of voluntary organization/Private Practitioners in various eye care activities, NGO/Private Practitioners provides financial assistance of Rs 2000/- for each cataract surgery. 15.6.1 I.1.1 Reimbursement for 2000 1500 30.00 Approved cataract operation Rs. 30.00 for NGO and Private lakh @ Rs. Practitioners as per 2000 per NGO norms case of @Rs.2000/- cataract operations
Programme Management Budget Quantity/ New FMR Old FMR Unit Approved Budget Head Physical Remarks Code Code Cost (Rs. In Target Lakh) U.16 Programme Management 0.30 National Program for Control of Blindness 16.1.5.3.10 16.7.3.9 Management of 30000 1 0.30 Budget of Health Society Rs. 30,000/- (Office Expenses) is approved.
Summary of Approval: NPCB
FMR Budget Head Total Approval (Rs. In Lakh)
U.2 Service Delivery- Community Based 2.82 U.6 Procurement 3.00 U.9 Training & Capacity Building 1.74 U.11 IEC/BCC 0.395 U.15 PPP 30.00 U.16 Programme Management 0.30 Total 38.255
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National Mental Health programme (NMHP)
It is estimated that 6-7 % of population suffers from mental disorders. The World Bank report (1993) revealed that the Disability Adjusted Life Year (DALY) loss due to neuro-psychiatric disorder is much higher than diarrhea, malaria, worm infestations and tuberculosis if taken individually. Together these disorders account for 12% of the global burden of disease (GBD) and an analysis of trends indicates this will increase to 15% by 2020 (World Health Report, 2001). One in four families is likely to have at least one member with a behavioural or mental disorder (WHO 2001). These families not only provide physical and emotional support, but also bear the negative impact of stigma and discrimination. Most of them (>90%) remain un-treated. Poor awareness about symptoms of mental illness, myths & stigma related to it, lack of knowledge on the treatment availability & potential benefits of seeking treatment are important causes for the high treatment gap.
Objectives: To ensure the availability and accessibility of minimum mental healthcare for all in the foreseeable future, particularly to the most vulnerable and underprivileged sections of the population; To encourage the application of mental health knowledge in general healthcare and in social development; and To promote community participation in the mental health service development and to stimulate efforts towards self-help in the community.
Strategy and Innovations proposed Integration with existing activities for optimal utilization of resources. Capacity strengthening of major component Developing linkages with various stakeholders According to gaps identified in Mission report Effective Intersectoral linkages Capacity development in project management Awareness generation and demand for services Stigma reduction and social dignity for the mentally ill Innovation at multiple levels of programme functioning Strengthened institutional and referral linkages for care and treatment of MH patients.
Human Resource Development (Training) To develop skills of human resource training has been imparted in support of NIMHANS Bangaluru and AIIMS, Rishikesh to Doctors, Staff Nurse and other staff under NCD programs 22 Doctors is trained in One Year Diploma Course under Mental Health. Training to total 60 Staff Nurse, Community Nurse and other staff under NCD programs has been imparted at AIIMS Rishikesh in support of NIMHANS Bangaluru. Training of Medical Officers and other staff is also scheduled in Financial Year 2020-21.
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Service Delivery- Community Based Budget Old Quantity/ New FMR Unit Approved FMR Budget Head Physical Remarks Code Cost (Rs. In Code Target Lakh) U.2 Service Delivery- Community Based 0.72 Psychiatrist recruited under DMHP, Doctors and other staff trained in support of NIMHANS, Bangaluru and AIIMS, Rishikesh will conduct outpatient clinics/camps at block level/schools/slum areas to identify patients with mental illness and to aware people regarding mental health. Two targeted intervention activities are to be conducted per month. 2.3.2.3 J.1.3 DMHP: Targeted 3000 24 0.72 Total budget of interventions at Rs. 72,000/- is community level approved @ Rs Activities & 3000/- per activity interventions targeted for 2 activities per at schools, colleges, month. workplaces, out of school adolescents, urban slums and suicide prevention.
Procurement Budget New Quantity/ Old FMR Unit Approved FMR Budget Head Physical Remarks Code Cost (Rs. In Code Target Lakh) U.6 Procurement 1.00 Budget of Rs. 1.00 lakh is approved for the procurement of psychotropic drugs as per the requirement raised by the Psychiatrists under NMHP/doctors trained under Mental Health in one year training program at NIMHANS, Bangaluru and AIIMS, Rishikesh.
6.2.16 B.16.2.11.5 Drugs and 1000 - 1.00 Approved Rs. supplies for 00 1.00 lakh NMHP
IEC/BCC Budget New Quantity/ Old FMR Unit Approved FMR Budget Head Physical Remarks Code Cost (Rs. In Code Target Lakh) U.11 IEC/BCC 0.50 11.19.2 B.10.6.12.b Awareness 50000 1 0.50 Budget of Rs. generation 50000 is activities in the approved for IEC community, activities and schools, observing Mental workplaces with Health Day. community involvement
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Programme Management
Budget New Quantity/ Old FMR Unit Approved FMR Budget Head Physical Remarks Code Cost (Rs. In Code Target Lakh) U.16 Programme Management 0.50 16.1.3.3. 16.3.3.13 Miscellaneous/ 50000 1 0.50 Budget of Rs. 13 Travel 50,000/- is approved.
Summary of Approval: NMHP
FMR Budget Head Total Approval (Rs. In Lakh)
U.2 Service Delivery- Community Based 0.72 U.6 Procurement 1.00 U.11 IEC/BCC 0.50 U.16 Programme Management 0.50 Total 2.72
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National Programme for the Healthcare of the Elderly (NPHCE) The population of elderly person is rapidly increasing globally. As per Census 2001, total population above 60 years of age in India was 76.6 million (7.5%). The data of 2011 Census is yet not available, but as per projection, the elderly population as on date is expected to be around 98 million. According to estimated projection the population of elderly will be around 12.4% of the total population by 2025. The National Sample Surveys of 1986-87, 1995-96 and 2004 have shown that: The burden of morbidity in old age is enormous. Non-communicable diseases (life style related and dangerative) are extremely common in older people irrespective of socio-economic status. Disabilities are very frequent which affect the functionality in old age compromising the ability to pursue the activities of daily living.
The objectives of the NPHCE are: To provide easy access to preventive, promotive, curative and rehabilitative services to the elderly. To make use of the community based primary health care approach and strengthen capacity of the medical and paramedical professional as well as the care-takers within the family for caring practices of the elderly. To identify health problems in the elderly and provide appropriate health interventions in the community with a strong referral backup support. To provide referral services to the elderly patients through district hospitals, medical colleges and strengthen health manpower development in the field of geriatric medicine.
Development of treatment models for the elderly persons in our state. Preventive and promotive care Management of Illness Health Manpower Development for geriatric services Medical rehabilitation and therapeutic intervention Developing appropriate training courses for medical and paramedical health professional in geriatric care. Promotion and encouraging basic, clinical, epidemiological and applied research in aging and the health care of the elderly Integrating other systems of medicine such as AYUSH in provision of health care to the elderly.
Service Delivery To provide better IPD service to elderly patients Geriatric Wards in all 13 districts has been established. Dedicated OPD service to elderly patients is also initiated in District Level Hospitals and CHCs and PHCs. In Financial Year 2020-21 approvals are received to strengthen health care services for elderly patients at CHC level. Approval for procurement of equipments and one position of Rehabilitation Worker/Physiotherapist is received for selected CHCs of the State.
Human Resource Development (Training) In Financial Year 2020-21 State ToT of Medical Officers will be conducted. State trainers will later impart training to Medical Officers of CHCs.
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Procurement
Budget New Quantity/ Old FMR Unit Approved FMR Budget Head Physical Remarks Code Cost (Rs. In Code Target Lakh) U.6 Procurement 4.00 National Program for Health Care of Elderly Budget is approved for procurement of machinery & equipments as per the GoI guidelines and requirement to strengthen the health services for elderly patients at CHC level. 6.1.1.21. K.2.2 Non-recurring 1000 4 4.00 Budget is 4 GIA: Machinery & 00 approved @ Rs. Equipment for 1.00 lakh per CHC CHC for 4 CHCs (Pratapnagar, Chham, Thatyur & Hindolakhal)
IEC/BCC
Budget New Quantity/ Old FMR Unit Approved FMR Budget Head Physical Remarks Code Cost (Rs. In Code Target Lakh) U.11 IEC/BCC 0.20 11.20.1 B.10.6.13 IPC,Group 10000 1 0.10 Budget of Rs activities and 10000 is mass media for approved for IEC NPHCE activities 11.20.2 B.10.6.13 Celebration of 10000 1 0.10 Budget of Rs days-ie 10000 is International Day approved for for older persons Observing World Elderly Day.
Summary of Approval: NPHCE
FMR Budget Head Total Approval (Rs. In Lakh) U.6 Procurement 4.00 U.11 IEC/BCC 0.20 Total 4.20
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National Oral health programme (NOHP)
National Oral Health Programme, a project of DGHS and Ministry of Health and Family Welfare was initiated in 1998 with aim of providing oral health care in the country through organized primary prevention and strengthening of Oral health setup as per the recommendations.
The programme has 3 basic components: To provide oral health education to masses through a network of Dental Surgeons, Health care Providers, Anganwadi Workers and School Teachers. To provide Information, Education and Communication material (IEC) to train the Health workers and for conveying oral health messages to the people through mass media. To formulate guidelines to strengthen oral health setup at District level, Community health Centers and Primary Health centers.
Service Delivery Strengthen the Dental Unit in all the health facility within the state. In Financial Year 2020-21 approvals are received to strengthen the selected Community Health Centres in all 13 District.
Infrastructure
Budget New Quantity/ Old FMR Unit Approved FMR Budget Head Physical Remarks Code Cost (Rs. In Code Target Lakh) U.5 Infrastructure 7.00 5.1.1.2.2 B.26.1.1 Renovation, 7000 1 7.00 Budget of Rs. Dental Chair, 00 7.00 lakh is Equipment- approved for District Hospital strengthening of Dental Unit at CHC Chamm.
Procurement
Budget New Quantity/ Old FMR Unit Approved FMR Budget Head Physical Remarks Code Cost (Rs. In Code Target Lakh) U.6 Procurement 1.00 National Oral Health Program 6.2.10.1 B.16.2.11.2 Consumables for 1000 1 1.00 Approval of Rs. NOHP 00 1.00 lakh for Dental Unit at DH
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IEC/BCC
Budget Quantity/ New FMR Old FMR Unit Approved Budget Head Physical Remarks Code Code Cost (Rs. In Target Lakh) U.11 IEC/BCC 0.10 11.24.4.2 IEC under NOHP 10000 1 0.10 Approved Rs.0.10 lakh for IEC at District level.
Summary of Approval: NOHP
FMR Budget Head Total Approval (Rs. In Lakh)
U.5 Infrastructure 7.00
U.6 Procurement 1.00
U.11 IEC/BCC 0.10
Total 8.10
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National Programme for Prevention and Control of Deafness (NPPCD)
Hearing loss is the most common sensory deficit in humans today. As per WHO estimates in India, there are approximately 63 million people, who are suffering from significant auditory impairment; this places the estimated prevalence at 6.3% in Indian population. As per NSSO survey, currently there are 291 persons per one lakh population who are suffering from severe to profound hearing loss (NSSO, 2001). Of these, a large percentage is children between the ages of 0 to 14 years. With such a large number of hearing impaired young Indians, it amounts to a severe loss of productivity, both physical and economic. An even larger percentage of our population suffers from milder degrees of hearing loss and unilateral (one sided) hearing loss.
Objectives To prevent the avoidable hearing loss on account of disease or injury. Early identification, diagnosis and treatment of ear problems responsible for hearing loss and deafness. To medically rehabilitate persons of all age groups, suffering with deafness. To strengthen the existing inter-sectoral linkages for continuity of the rehabilitation programme, for persons with deafness. To develop institutional capacity for ear care services by providing support for equipment and material and training personnel.
Components of the Programme: MANPOWER TRAINING & DEVELOPMENT – For prevention, early identification and management of hearing impaired and deafness cases, training would be provided from medical college level specialists (ENT and Audiology) to grass root level workers. In Financial Year 2020-21 approval is received for training of Medical Officers in support of AIIMS, Rishikesh.
CAPACITY BUILDING – for the District Hospital, Sub-District Hospital, CHC and PHC in respect of ENT/Audiology infrastructure.
SERVICE PROVISION INCLUDING REHABILITATION – Screening camps for early detection of hearing impairment and deafness, management of hearing and speech impaired cases and rehabilitation (including provision of hearing aids ), at different levels of health care delivery system.
AWARENESS GENERATION THROUGH IEC ACTIVITIES – for early identification of hearing impaired, especially children so that timely management of such cases is possible and to remove the stigma attached to deafness.
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IEC/BCC
Budget Quantity/ New FMR Old FMR Unit Approved Budget Head Physical Remarks Code Code Cost (Rs. In Target Lakh) U.11 IEC/BCC 0.20 National Program for Prevention & Control of Deafness Budget is approved @ Rs. 20,000 for Observing World Hearing Day & organising other IEC activities under NPPCD. 11.11.1 IEC/BCC activities 20000 1 0.20 Approved Rs. under NPPCD 20000/-
Summary of Approval: NPPCD
FMR Budget Head Total Approval (Rs. In Lakh)
U.11 IEC/BCC 0.20 Total 0.20
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National Programme for Palliative Care (NPPC) Introduction Palliative Care is an essential component of Cancer Control Programme and Health Care of the Elderly and can be effectively provided in conjunction with these programmes reducing the morbidity burden to a great extent.
Goal: Availability and accessibility of rational, quality pain relief and palliative care to the needy, as an integral part of Health Care at all levels, in alignment with the community requirements.
Objectives Improve the capacity to provide palliative care service delivery within government health programs such as the National Program for Prevention and Control of Cancer, Cardiovascular Disease, Diabetes, and Stroke; National Program for Health Care of the Elderly, the National AIDS Control Program, and the National Rural Health Mission. Refine the legal and regulatory systems and support implementation to ensure access and availability of Opioids for medical and scientific use while maintaining measure for preventing diversion and misuse Encourage attitudinal shifts amongst healthcare professionals by strengthening and incorporating principles of long term care and palliative care into the educational curricula (of medical, nursing, pharmacy and social work courses). Promote behavior change in the community through increasing public awareness and improved skills and knowledge regarding pain relief and palliative care leading to community owned initiatives supporting health care system. Encourage and facilitate delivery of quality palliative care services within the private health centers of the state. To contribute in developing National standards for palliative care services and continuously evolve the design and implementation of the National program to ensure progress towards the vision of the program.
Service Delivery- Facility Based Budget New Quantity/ Old FMR Unit Approved FMR Budget Head Physical Remarks Code Cost (Rs. In Code Target Lakh) U.1 Service Delivery- Facility Based 0.60 National Program Palliative Care 1.3.2.5 B.27.1.3 Miscellaneous 6000 1 0.60 Budget of Rs. including Travel/ 0 0.60 lakh is POL/ Stationary/ approved for Communications/ Miscellaneous. Drugs etc.
Summary of Approval: NPPC FMR Budget Head Total Approval (Rs. In Lakh) U.1 Service Delivery- Facility Based 0.60 Total 0.60
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Pradhan Mantri National Dialysis Program (PMNDP)
In financial year 2016-17 Government of India has launched Pradhan Mantri National Dialysis Program under PPP mode. Major objective of the program is to provide dialysis services in government health facilities at reasonable rates. Government of India has fixed the price capping of Rs. 1100/- for per dialysis for both BPL & APL patients. Payment for Dialysis facility to the patients from below poverty line (BPL) patients will be paid through National Health Mission. For non BPL patients the benefit of accessing the services will be at the same rates as paid by Government for the BPL patient.
Service Delivery Under the program 9 Dialysis Centers is established/functional in the State- Sl.No. Dialysis Centre Mode Machines
1. Coronation Hospital, Dehraun PPP 10 2. Base Hospital, Haldwani, Nainital PPP 10 3. District Hospital Rudrapur, PPP 10 Udham Singh Nagar 4. Mela Hospital, Haridwar PPP 10 5. Combined Hospital Kotdwar, PPP 10 Pauri Garhwal 6. Base Hospital, Almora State Run Model 03
7. Medical College Srinagar, Pauri State Run Model 03 Garhwal 8. District Hospital Rudrapryag State Run Model 03
9. District Hospital Pithoragarh State Run Model 03
In Financial Year 2020-21 one more Dialysis Centre will be established under PPP Mode in Sub-District Hospital Roorkee (Haridwar) with 3 dialysis machines.
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National Iodine Deficiency Disorders Control Program
Iodine deficiency disorder is a serious threat to the health, well-being, economic productivity and advancement of several hundred million people throughout the world. People living in iodine deficient environment and consuming only locally grown food suffer from reduced mental abilities. Iodine is an essential micro nutrient. It is required at 100-150 micrograms daily for normal human growth and development. National Iodine Deficiency Disorders Control Program (NIDDCP) is being implemented in order to prevent, control and eliminate these disorders and to provide assistance for setting up of IDD Cell and IDD monitoring laboratories for ensuring quality control of iodated salt and for monitoring urinary iodine excretion. Survey of IDD and health education activities will also conducted through the program. In Financial Year 2020-21 following activities will be conducted under the program- Strengthening of laboratory for iodine testing. Procurement of Salt Testing Kit for ASHA worker. Testing of salt used in households, schools, and also from retail shops by ASHA worker. Incentive to ASHA worker for salt testing.
Community Interventions
Budget New Old Quantity/ Unit Approved FMR FMR Budget Head Physical Remarks Cost (Rs. In Code Code Target Lakh) U.3 Community Interventions 0.079 ASHA worker will collect total 100 samples of salt used in households, schools, and also from retail shops of her catering area. ASHA worker will receive Rs. 0.50 for collection of per sample and reporting of the same to concern CHC/PHC. Salt Testing Kits will be provided to each ASHA worker. Salt sampling will be conducted in blocks approved for Health & Wellness Centres.
3.1.1.5.1 D.5 ASHA Incentive 50 157 0.079 Budget approved under NIDDCP @ Rs. 0.50 per sample.
Procurement
Budget New Quantity/ Old FMR Unit Approved FMR Budget Head Physical Remarks Code Cost (Rs. In Code Target Lakh) U.6 Procurement 0.33 Procurement of Salt Testing Kits (STK) for ASHA Workers of blocks approved for Health & Wellness Centres in the district. Approval of Rs. 35 per STK is received from GoI. ASHA worker will collect total 100 samples of salt used in households, schools, and also from retail shops of her catering area. 6.2.11. D.4 Supply of Salt 35 942 0.33 Budget 1 Testing Kit approved @ Rs. 35 per STK.
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IEC/BCC
Budget Quantity/ New FMR Old FMR Unit Approved Budget Head Physical Remarks Code Code Cost (Rs. In Target Lakh) U.11 IEC/BCC 0.20 Budget is approved @ Rs. 20,000 for Observing World Iodine Day & organising other IEC activities under NIDDCP. 11.14.1 IEC/BCC activities 20000 1 0.20 Approved Rs. under NIDDCP 20000/-
Summary of Approval: NIDDCP FMR Budget Head Total Approval (Rs. In Lakh) U.3 Community Interventions 0.079 U.6 Procurement 0.33 U.11 IEC/BCC 0.20 Total 0.609
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Committed for FY 2020-21 Tehri New Old FMR Budget (Rs. FMR Budget Head Remarks Code in Lakhs) Code MCH LaQshya Related 1.1.1.5 1.1.1.5 1.49 For LaQshya Menniquine Activities 12.1.2 12.1.2 Printing of MCP Card 2.80
District Dissemination on 11.4.2 11.4.2 0.50 Anemia Mukt Bharat
Equipment approved- Procurement of new NBSU at PHC 6.1.1.2.4 6.1.1.2.b SNCUs/NBSUs 2.75 Partapnagar Hospital@ equipments Rs. 2.75 Lakhs as per FBNC guideline.
Immunization
9.5.10.2 Any other (Please specify) 73.18
ASHA 3.1.2.4 Certification of ASHA by NIOS 25.34
6.1.6.2b Any other (Procurement of Desktop) 2.7
NPCDCS
Any Other ASHA 3.1.1.5.2 1.50 Incentive (Please specify)
Training for Universal 9.5.19.3 0.60 Screening for NCDs Covid -19 Covid -19 12.00 Total 122.86
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